NUR 163 Exam II Study Guide

NUR 163 Exam II Study Guide
1. Levels of prevention and how they apply to diet and weight management
o PowerPoint/Lecture
 Primary Prevention: Implementation of a practice that is likely to prevent
disease.
 Weight management is primary prevention to prevent future
disease processes related to obesity.
 Secondary Prevention: Institution of monitoring techniques to discover
incipient diseases early enough to enhance the opportunity to control their
effects.
 Prediabetes which can be managed with diet and exercise to
prevent or delay the onset of type II diabetes.
 Tertiary Prevention: Use of treatment techniques after a disease has
occurred to prevent complications or to promote maximum adaptation.
 People with dysphagia who undergo physical therapy to avoid
choking while eating.
o Textbook
 Primary Prevention: Likely to avert the occurrence of disease. Difficulty
lies in motivating people to change behavior today for possible benefits in
the perhaps distant future.
 Maintaining healthy body weight is a primary prevention strategy.
 Secondary Prevention: If person’s risk for diabetes is found in the
prediabetes stage by testing blood sugar levels, noninvasive txs such as
weight loss and diet modification can successfully derail or delay the
development of the disease.
 Tertiary Prevention: Pt’s with various diseases that cause swallowing
disorders can be helped to maintain nourishment and avoid choking
incidents with nutritional interventions.
2. Understand how theoretical models can apply to local, state, and government
initiatives for healthy life style choices.
 Social-Ecological Model Framework
 People make their own choices about food/exercise
 Other elements of society should try to encourage individuals to
make America healthy.
 Base
 Food and beverage intake
 Physical Activity
 Individual Factors
 Demographic factors
 Age
 Gender
 Socioeconomic status
 Race/ethnicity
 Disability status
 Psychosocial factors
 Knowledge and skills
 Gene-Environment interactions
 Other personal factors
 Environmental Settings
 Homes
 Schools
 Workplaces
 Recreational Facilities
 Foodservice and retail establishments
 Other community settings
 Sectors of influence
 Government
 Public Health and Health Care Systems
 Agriculture
 Marketing/Media
 Community design and safety
 Foundations and funders
 Industry
 Food
 Beverage
 Physical activity
 Entertainment
 Social and Cultural Norms and Values
 Belief systems
 Heritage
 Religion
 Priorities
 Lifestyle
 Body Image
3. 3 Categories of Nutrients
 Essential: One the human body requires but can’t manufacture in
sufficient amounts to meet bodily needs.
 Non-essential: Not needed in the diet b/c the body can make them from
other substances.
 Conditionally essential: Those that the body can manufacture in sufficient
quantities under most circumstances.
o Textbook
 Essential: 40 total. Examples: Vit. C & A and Ca+
 Nonessential: Amino acid alanine; the body makes it from other raw
materials.
 Conditionally essential: A healthy person can make. In certain situations
of physiological status or disease, the body cannot produce optimal
amounts. Example: Amino acid tyrosine.
4. 6 classes of nutrients
 Carbohydrates
 Fats
 Proteins
 Vitamins
 Minerals
 H2O
5. 3 functions of nutrients are and what this is called.
 Serve as a source of energy or heat
 Support the growth and maintenance of tissue
 Aid in the regulation of basic body processes
 These 3 functions collectively known as metabolism
o Textbook
 All nutrients perform 1 or more of the following functions.
 The sum of all physical and chemical changes that take place in the body.
 Nutrients have specific metabolic functions and interact with 1 another to
maintain the body.
 Source of energy or heat
 Energy = physical sciences as the capacity to do the work.
 Forms = electric, thermal (heat), chemical, mechanical and others.
 All food enters the body as chemical energy and then the body
processes and converts.
 Measured in kilocalories (kcal)
 Growth and Maintenance of Tissue
 H2O, proteins, fats, and minerals contribute in a major way to
build body structures.
 Regulation of Body Processes
 Certain minerals and proteins help regulate how H2O is
distributed in the body.
 Vitamins are necessary. Not energy sources but if lacks a
particular vitamin it will not produce energy efficiently.
6. Meaning of Recommended Dietary Allowance
 Intake that meets the needs of 97-98% of individuals in the defined group.
 Defined group = US population
 Formed because we had enough food but the food we were eating didn’t
have enough nutrients to maintain health.
 Bread enriched with thiamine, niacin, iron, and riboflavin
(Wonder Bread)
7. Types of Monosaccharides
 Contain 1 molecule of C6H1206 (Carbon, hydrogen, and O2)
 Glucose: What is measured for blood sugar
 Fructose: The sweetest, found in fruits and honey. Most controversial
sugar b/c of the issues surrounding high fructose corn syrup and diabetes
link. Countries that use have 20% increased incidence in diabetes.
55lb/year consumption rate. Other countries consume 1lb/year.
 Galactose: Derived from the lactose in milk products
 Building blocks of all other carbs.
 All are converted to glucose for energy needs.
o Textbook
 Building blocks of all carbs.
 Glucose
 Major form of sugar in the blood
 Body readily converts all forms of sugar consumed to it.
 Also called dextrose.
 Normal FBS is 70-100 mg/100 mm
 Impaired fasting glucose: 100-125 mg/100 mm
 Fructose
 Used in soft drinks, canned foods, and processed foods.
 Galactose
 Mainly from the breakdown of milk sugar lactose.
 Yogurt and unaged cheese
 Least sweet
8. Disaccharides and their constituents
 Two-linked Monosaccharides
 Sucrose: Table sugar, glucose and fructose paired
 Lactose: Milk sugar, glucose, and galactose paired
 Maltose: Occurs during starch digestion, glucose + glucose
o Textbook
 Sucrose: Most prevalent. White table sugar; Brown, granulated;
Powdered; Molasses/Maple Syrup; Fruits & Veggies.
 Lactose: Occurs naturally only in milk. “Milk sugar”. Least sweet.
 Maltose: Double sugar. Produced when body breaks starches into simpler
units. Present in malt, malt products, beer, infant formulas, and sprouting
seeds.
9. What basic molecule results when monosaccharides are broken down.
 ALWAYS GLUCOSE! Everything gets converted to it.
10. Functions of carbs in the body
 Fuel: Recommended dose is 130g/deciliter or 45-65% of what you eat
should be carbs.
 Protein sparing: Keeps the body from catabolizing the muscle.
 Prevents ketosis: Byproducts of fat and protein metabolism
 Enhanced learning and memory: Blood glucose levels regulate neural and
behavioral processes, high levels of blood sugar can increase the incidence
of mild cognitive impairment or dementia.
 If you don’t have enough carbs body will eat muscle (including heart and
causing MI). Protein leads to glucagon leads to glucose and this occurs
when you don’t have enough carbs and then don’t get enough protein.
o Textbook
 Fuel: Primary source is carbs. Brain is a carb-dependent organ and must
have an uninterrupted, ongoing source.
 Spare Body Protein: When too few carbs are eaten, the body suffers.
Continuous supply of glucose is required for all cells to function,
particularly CNS. Glycogen stores are limited and once depleted the body
can convert protein to glucose. Body breaks down muscle tissue before fat
stores if carb intake is inadequate.
 Prevent Ketosis: If carb intake is too low the body will breakdown stored
fat and internal protein to meet fuel needs. Body can’t handle excessive
breakdown b/c it lacks equipment. Partially broken-down fats accumulate
in the blood as ketones = state of ketosis. Survival is possible but good
health is not! Ketosis causes fatigue, N, and lack of appetite. Coma and
death occur in severe cases. 130g is usually enough to prevent!
 Enhance Learning and Memory: Glucose consumed early in the morning
facilitates specific forms of cognitive function especially verbal
declaration memory. Eating breakfast = higher test scores. Diets high in
carbs increase the incidence of mild cognitive impairment or dementia in
elderly.
11. Minimum RDI of Carbs
o PowerPoint/Lecture and Textbook
 130 grams!!!!!
12. Protein Catabolism in Diabetes
 Protein
o Textbook
 Breaking down of tissues into simpler substances that the body can reuse
or eliminate.
 Breaking down into amino acids, reused for building new tissue and
repairing old tissue.
13. My Plate Portion Recommendations
o Textbook
 Promoted by USDA
 Intent is to reduce risks for obesity, diabetes, CV disease, cancer, and
other chronic diseases by helping consumers to eat correct proportions of
healthy foods meal by meal.
14. Food Groups Contain Carbs, Proteins, and Fats from ADA food exchange list
o Textbook
 KEYSTONES PG. 44
 Carbs are composed of sugars and starches
 Average American’s intake of sugar is excessive but intake of
starches are low.
 Benefit from increasing fiber intake through whole-grain starches,
fruits, and veggies.
 Carbs promote tooth decay in susceptible individuals
 ADA exchange lists contain carbs = starch, veggie, fruits, and milk
lists.
 Strong evidence exists that min of 130g of carbs per day is
necessary for adequate brain and body function
 When no or little carbs in diet and body uses protein or fat as a fuel
source, the body effect cannibalizes itself for glucose. Muscle and
organ mass is lost in process.
 RDA for CHO is 130g of carbs a day. Pregnant and lactating have
a higher RDA for CHO.
 Fats exchange list
 Milk: Varies according to type. Whole milk = 8, 2% = 5, Nonfat =
Trace.
 Meat: 1 lean meat = 0-3 g, 1 med. Fat meat = 4-7g, 1 high fat meat
= 8 or more g
 Keystones on pg. 60
 Fats are lipids
 Hydrogen, O2, and carbon are primary elements
 G for g, fats contain more than twice the kcal of carbs
 Labeled according to amount and type of fatty acids they contain
as sat., unsat., monosat, polyunsat, and trans
 Many important functions in our diets and bodies
 Balanced intake of carb and fat = optimal health. Excess fats are
associated w/ CV disease, obesity, diabetes, and types of cancer.
 Cholesterol is fatlike substance that is present in animal food
sources and produced by human body.
 Need to decrease intake of cholesterol, trans-fatty acids, and sat.
fat.
 20-35% of kcal from fat
 Dietary guidelines recommends a sat. fat intake of less than 10%
of kcal and dietary cholesterol intake of less than 300 mg per day.
 ADA exchanges contain fat are the milk, meat, and fat lists.
15. How many g of carbs are in serving of common starches, fruits, veggies, and milk
lists.
 Each serving contains about 15g of carbs
 Starches/Bread
 Veggies: 1 veggie exchange contains 5 grams of carbs and 2-3
grams of fiber
 Fruit: 1 fruit exchange contains 15 g of carbs, also have fiber,
vitamins, minerals
 Milk: 1 c contains 12 g of carbs
o Textbook
 Starches: ½ c cereal, ½ c cooked beans, ½ c corn, 1 sm. Baked potato, 1
slice of whole wheat bread.
16. How many g of protein are in a serving of beef, chicken, fish, and eggs.
o Internet
 Chicken: 22-28 grams
 Beef: 22 grams
 Fish: 39 grams
 Eggs: 6 grams
17. Glycogen and how it’s stored
 Derived from protein and stored in liver and is used to make glucose
o Textbook
 Body’s carb stores.
 Stored in liver and muscle tissue as polysaccharide.
 Crucial to function of human body.
 During intense physical activity, the body utilizes blood glucose for
energy.
 Helps sustain blood glucose levels during sleep
18. How long you can live without food and how long you can live without fresh water
 Humans can live a month without food but only 6 days w/o H2O
19. What nutrient gives food containing fat it’s taste
o PowerPoint/Lecture/Textbook
 Lipids/fats
 Fatty acid chains w/ glycerol
20. Most common fat that is found in the body
 Triglycerides
21. What degree of saturation of fats
 Saturation depends on when hydrogen molecule is joined to the carbon
atoms.
 Saturated Fatty Acids: As many hydrogens that can bond with the carbon
molecules w/o forming double bonds btwn neighboring carbons.
 Unsaturated Fatty Acids: Carbon molecules are connected w/ double
bonds, it could feasibly take on more hydrogen
 Monosaturated fats: A fatty acid w/ only 1 double bond btwn 2 carbon
atoms.
 Polyunsaturated Fats: A fatty acid w/ more than 1 double bonded pairs of
carbon atoms.
 Trans-fatty acids: Composed of partially hydrogenated fatty acids
o Textbook
 Saturated Fats: Composed mostly of saturated fatty acids
 Unsaturated fats: Composed mostly of unsaturated fatty acids
 Monounsaturated fat: Composed mostly of monounsaturated fatty acids
 Polyunsaturated fat: Composed mostly of polyunsaturated fatty acids
 Trans-fatty acids: Composed of partially hydrogenated fatty acids.
22. Know the essential fatty acids and what they do
 Linoleic: Keeps the skin impermeable to H2O. Gets broken down into
arachidonic acid.
 Arachidonic forms prostaglandins and thromboxanes – Hormone-like
lipids that promote blood clotting, induce inflammation and cause SmM
contraction. Can also form leukotrienes, which are 1 of the most potent
inflammatory agents in the human organism.
 Linolenic decrease the risk of heart disease by helping to maintain normal
heart rhythm and heart pumping, it might also reduce blood clots, although
alpha-linolenic acid seems to benefit the CV system and might reduce the
risk of heart disease research to date does not know it has a significant
effect on cholesterol levels.
23. What meat and dairy products are high in saturated fats.
 Visible fat on any kind of meat
 Hot dogs, sausage, bacon, lunch meats, pastrami, bologna
 All poultry and fowl
 Cheeses made with whole milk or cream, condensed milk, yogurt, all
creams.
o Textbook
 Marbling in beef, pork, and lamb especially in prime-grade and ground
meats, lard, suet, salt pork
 Frankfurters
24. Recommended intake of saturated fat per day
 Less than 10% of calories per day
25. How Lipitor and other common cholesterol medications work
26. Know function of proteins in the body
 Provision of structure: Contractile proteins found in muscle and fibrous
proteins, such as collagen, make up the vast majority of the body’s mass
 Maintenance and growth: Anabolism builds up tissue and catabolism tears
down tissue both processes happen at the same time in the body for
maintenance and growth. Nitrogen balance is maintained when this
process is in equilibrium.
 Regulation of body processes: Enzymes, hormones, DNA, and RNA are
proteins that regulate body processes.
 Immunity: Antibodies are produced in the body as a result of the presence
of foreign substances. There is a specific antibody for every foreign
substance encountered.
 Circulation: Albumin maintains blood volume by drawing fluid back into
veins from body tissues. This helps regulate blood pressure.
 Energy source: Used as a source of back up energy for the brain and spinal
cord when glucose isn’t readily available, a process called
gluconeogenesis.
o Textbook
 Albumin is main protein in blood
 Glucose is the most efficiently used source of energy, fat and protein are
backup.
27. What elements make up a protein
 Carbon
 Hydrogen
 O2
 Hydrogen
 Elements are arranged in building blacks called amino acids.
 Presence of nitrogen that makes a protein different from carbs and fats.
 Sometimes these protein molecules can contain sulfur or other molecules.
28. What disease you get from eating improperly processed cassava roots
 Contain cyanide as a denfense mechanism to protect the plant from being
eaten by wild animals.
 It’s easy to grow provides a main food source for some impoverished
nations in Africa.
 Flour made from improperly processed cassava, or eating the raw roots,
can lead to a paralytic disease called konzo.
 Kids under 3 and child-bearing women suffer most often.
 Stone fruit pits also contain high levels of cyanide
29. What kind of poisoning you can get from improperly soaking kidney beans
 Konzo a paralytic disease can also occur from red kidney beans that aren’t
properly soaked.
30. How many essential amino acids exist
 23 essential amino acids
31. How many grams of amino acids are derived from food per day with a balanced diet
 90 grams
32. What defect in amino acids of the hemoglobin causes sickle cell trait and anemia.
 Glutamic acid has been replaced by valine at a specific location on the
protein chain.
33. What population groups are most affected by sickle cell anemia
 African Americans are #1
 Mediterranean decent
 Always ask ethnicity
34. Maple Syrup Urine Disease
 Caused by defective metabolism of the branched chains of amino acids
 Death will result in 7-10 days in severely affected infants
 Minor variations of this condition may only manifest w/ a diet heavy in
protein or under stress.
 Tx requires restriction of foods containing certain amino acids, isoleucine,
leucine, and valine to only 20-40% during infancy and childhood to
prevent brain damage.
 Other tx can consist of blood transfusions or liver transplant if disease is
severe.
 Amish people
35. PKU in infants
 Women with PKU have a very high rate of having infants with mental
deficiencies or cardiac defects as a result of their condition.
 People born w/ this genetic condition are unable to convert phenylalanine
into tyrosine b/c the enzyme phenylalanine hydroxylase is missing.
 If left untreated, irreversible brain damage can occur w/i the first 2 weeks
of life.
 Special formulas are prescribed that lack excessive amounts of
phenylalanine to prevent build up in the baby’s system.
o Textbook
 Older adults showed improvement w/ individualized diet and/or
medication therapy.
 Diet
 Avoidance of excess phenylalanine
 8-10% of protein prescribed should be as tyrosine b/c tyrosine
supplements alone won’t prevent mental retardation.
 Corn syrup, sugar, and pure fats
 Carefully selected amounts of fruits, veggies, and low-protein
breads and pastas but no high-protein foods.
 No aspartame
36. Functions of protein in the body
See question 26
37. Causes of Marasmus and Kwashiorkor
 Marasmus
 Malnutrition/Starvation
 Kwashiorkor
 Enough carbs but not enough protein
 Normally happens 1st year after stopping breastfeeding
 Get swollen bellies
o Textbook
 Marasmus
 Too few kcal and insufficient protein
 Wasting away
 Children in developing countries, cancer, AIDS
 Kwashiorkor
 Not enough protein to support growth
 Looks chubby
 Cause of swelling is fluid retention
38. Classifications of dietary protein
 Complete proteins: Supply all 9 essential amino acids not made by the
body in sufficient amounts to maintain tissue and support growth.
 Incomplete proteins: Lack 1 or more of the 9 essential amino acids
 Food that will provide complete proteins are from animal sources likes
meats, poultry, fish, eggs, milk, and cheese.
 Person on 2,000 cal diet need to eat 5-6.5 oz of meat and drink 3 cups of
milk per day.
o Textbook
 Protein foods are classified by the number and kinds of amino acids they
contain.
 Complete proteins: Meat and milk are both good sources.
 MyPlate instructs the servings needed
 Incomplete: Different types of plant foods can be combined to provide all
essential amino acids. Grains, veggies, legumes, nuts, and seeds.
39. What combinations of food constitute a complete protein
?
40. Kilocalories
 1000 kilocalories = 1 calorie
 1 g of carbs = 4 kcal
 1 g of protein = 4 kcal
 1 g of fat = 9 kcal
 1 g of ETOH = 7 kcal
41. How many calories are in 1 g of carbs, lipids, proteins, and ETOH
See question 40
42. How to calculate the number of calories needed to maintain body weight
 To get 1% divide by 100
 Then multiple by %
43. What constitutes energy expenditure
 Represents the energy required by a person at rest
 Powers the contraction of the heart, maintenance of body temp, repair of
internal organs, maintenance of cellular processes, muscle and nerve
coordination, respiration
 Differ between men and women
 Lower 1-2% every decade after age 20
 Genetically larger people will require more kcals
 Being in an outdoor climate
44. How many calories are burned w/ moderate and vigorous exercise
 Physical activity requires anywhere from 25-50% of human energy
expenditure
 Increased activity decreases appetite as long as eating disorders aren’t
involved.
 Those w/ leaner muscle mass burn kcal more efficiently than those people
w/ higher ratio of fat to lean muscle.
 Mod. = walking
 Vig. = Jogging
o Textbook
 1 hour walking = 140 kcals
 1 hour jogging = 295 kcals
45. Best way to monitor caloric needs
 Portions
46. Fat soluble vitamins
 DAKE
 D: MILK
 Deficiency = Rickets, Osteomalacia
 S&S = Bowlegs, knock knees, misshapen skulls
 Sources = Sunlight, milk, cod liver oil, fatty fish, eggs, liver, cereal
 A: CARROTS
 Deficiency = Night blindness, Xerophithalmia
 S&S = Night blindness, blindness, growth retardation, infertility,
intercranial pressure
 Sources = Carrots, spinach, collards, squash, apricots, sweet
potatoes, broccoli, cabbage, fortified milk, fish, egg yolk
 K: RAW SPINACH. Need to clot blood.
 Deficiency = None
 S&S = Prolonged clotting time
 Sources = Collards, spinach, brussels sprouts, cabbage, broccoli,
soy and canola oils
 E: SAFFLOWER OIL
 Deficiency = None
 S&S = Muscle pain, weakness, anemia, ataxia
 Sources = Sunflower, safflower, canola, almonds, hazelnuts,
peanuts, broccoli, cooked spinach, ready to eat cereals
47. Know what foods contain fat soluble vitamins
See question 46
48. Vitamin deficiency diseases and vitamin food sources
For fat soluble vitamins see question 46
 Water Soluble Vitamins
 Thiamin- B1: PORK LOIN
 Deficiency: Beriberi
 S&S: Muscle weakness, anorexia, weight loss, peripheral
neuropathy, right heart failure, Wenicke’s
encephalopathy
 Food sources: Pork, beef liver, salmon, black beans,
wheat germ, fortified cereals
 Riboflavin- B2: MILK
 Deficiency: Ariboflavinosis
 S&S: Lesion on lips, mouth, seborrheic dermatitis,
normochromic & normocytic anemia
 Food sources: Milk, dairy, eggs, meats, liver, fortified
cereal
 Niacin- B3: TUNA
 Deficiency: Pellagra = skin issues from niacin deficiency.
Causes flushing if you have too much.
 S&S: Dermatitis on face, neck, hands, and feet, diarrhea,
dementia
 Food sources: Liver, tuna, meats, fish, poultry, fortified
and enriched grains, coffee, tea
 Pyroxidine- B6: BANANAS
 Deficiency: None
 S&S: Mouth lesions, peripheral neuropathy, confusion,
hypochromic, microcytic anemia, convulsions in infants
 Food sources: Sirloin steak, salmon, chicken breast,
whole grains, fortified cereals, bananas
 Folate Folic Acid: CANNED PINTO BEANS. Decreases risk of
neural tube defects in babies.
 S&S: Bright red tongue, fatigue, weakness, SOB, heart
palpitations, megoblastic anemia
 Food sources: Liver, dried peas, beans. Lentils, wheat
germ, peanuts, asparagus, endive, lettuce, brussels
sprouts, liver, fortified grain products
 Cobalamin: CANNED SALMON
 S&S: Pernicious anemia, vit. B12 deficiency, Fatigue,
pallor, SOB
 Pantothenic Acid: SHITAKE MUSHROOMS
 S&S: Burning feet syndrome
 Food source: Liver, chicken, egg yolk, yogurt, legumes,
mushrooms, potatoes, broccoli, whole grain cereal
 Biotin: LARGE EGGS
 S&S: Alopecia, scaly red rash around the eyes, nose, and
mouth, parathesias of extremities, depression, and
hallucinations
 Food sources: Liver, eggs, salmon, peanuts, milk, sweet
potatoes, soybeans
 Choline: LARGE EGGS
 S&S: Liver and muscle damage
 Food sources: Liver, eggs, beef, pork, milk, yogurt, baked
beans
 Vit. C- Scurvy
49. Role minerals play in the diet
 Calcium: MILK. Teeth and bone
 Deficiencies: Tetany, osteoporosis, rickets
 Excesses: Calcification of soft tissue
 Food Sources: Milk products, salmon, sardines w/ bones, clams,
oysters
 Phosphorus: SOCKEYE SALMON. Buffer. Cells respirate
 Deficiencies: > Ca+ excretion, bone loss, muscle weakness
 Excesses: Tetany, convulsions, renal insufficiency
 Food sources: Lean meat, fish, poultry, milk, nuts, legumes
 Sodium: SALT
 Deficiencies: Hyponatremia
 Excesses: Hypernatremia
 Food sources: Table salt, processed food, milk and milk products
 Potassium: CANNED WHITE BEANS
 Deficiencies: Hypokalemia
 Excesses: Hyperkalemia
 Food sources: Banana, cantaloupe, winter squash, green leafy
veggies, legumes, salt substitute
 Magnesium: SPINACH
 Deficiencies: Impaired CNS function, tetany
 Excesses: Weakness, depressed respirations, cardiac arrest
 Food sources: Green leafy veggies, seafood, peanut butter,
legumes, coffee, cocoa
 Sulfur:
 No deficiencies or excesses
 Food sources: Complete protein foods
 Chloride: SALT. Important in pre-term infants due to F&E imbalance
and dehydration
 Deficiencies: Neuro damage in infants
 Excesses: none
 Food sources: Table salt, salty snacks, processed foods, eggs,
meat, seafoods
50. What osmosis is and the H2O compartments in the body
 Osmosis
 Fluid compartments exist throughout the body
 Fluid passes through the membranes of these compartments by
osmosis
 13 proteins that control the process of osmosis = Aquaporins
51. Know how to do an I & O

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