basic human needs nutrition. nutrients: the biochemical units of nutrition body requires fuel to...
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Basic Human Needs
Nutrition
Nutrients: The Biochemical units of
nutrition Body requires fuel to provide Body requires fuel to provide
energy for cellular metabolism and energy for cellular metabolism and repair, organ function, growth & repair, organ function, growth & body movementbody movement
Food is the fuel that keeps the Food is the fuel that keeps the machine that is our body runningmachine that is our body running
Energy requirements based on:
Basal metabolic rate (BMR)-Energy needed to Basal metabolic rate (BMR)-Energy needed to maintain life sustaining ( Breathing, maintain life sustaining ( Breathing, circulation, temperature, heart rate)circulation, temperature, heart rate)
Resting Energy Expenditure (REE)-Resting Energy Expenditure (REE)-measurement that accounts for BMR plus measurement that accounts for BMR plus energy needed to digest food & perform mild energy needed to digest food & perform mild activity. Accounts for 60-70% of our daily activity. Accounts for 60-70% of our daily needsneeds
Nutrients
Elements necessary for body Elements necessary for body processes & functionprocesses & function
6 Categories6 Categories Carbohydrates, Proteins, Fats, Carbohydrates, Proteins, Fats,
Water, Vitamins, MineralsWater, Vitamins, Minerals
Carbohydrates
Main source of energy (55-60% of Main source of energy (55-60% of calories in diet)calories in diet)
Each gram = 4 kcalEach gram = 4 kcal Composed of carbon, hydrogen & oxygenComposed of carbon, hydrogen & oxygen Main source of fuel (glucose) for brain, Main source of fuel (glucose) for brain,
skeletal muscle during exercise, RBC skeletal muscle during exercise, RBC &WBC production, cell function of renal &WBC production, cell function of renal medullamedulla
Obtained from plant foods, except for Obtained from plant foods, except for lactose (milk, sugarlactose (milk, sugar))
Simple Carbohydrates
Classified according to saccharidesClassified according to saccharides Monosaccharide- glucose(dextrose), Monosaccharide- glucose(dextrose),
fructose, galactose (building blocks of fructose, galactose (building blocks of all other CHO)all other CHO)
Glucose- blood sugar (normal fasting Glucose- blood sugar (normal fasting BS=70-100 mg/ml)BS=70-100 mg/ml)
Disaccharide- sucrose, lactose, Disaccharide- sucrose, lactose, maltose,maltose,
Sugar alcohols-sugar replacersSugar alcohols-sugar replacers Artificial sweetnersArtificial sweetners
Complex Carbohydrates
Polysaccharides are complex Polysaccharides are complex carbohydrates carbohydrates
Starches, glycogen, & fiber are Starches, glycogen, & fiber are polysaccharidespolysaccharides
Starches are the major source of CHO in Starches are the major source of CHO in diet (grains, cereals, breads, pasta, diet (grains, cereals, breads, pasta, starchy vegetables & legumes)starchy vegetables & legumes)
Glycogen- animal starch (found in liver & Glycogen- animal starch (found in liver & muscle tissue, provides immediate fuel muscle tissue, provides immediate fuel for muscle action for muscle action
Dietary Fiber
Plant foods that cannot be broken Plant foods that cannot be broken down by body to digestdown by body to digest
Fiber eliminated by intestinal wasteFiber eliminated by intestinal waste Adds volume, no fuel or energyAdds volume, no fuel or energy Fiber in diet helps promote regularity Fiber in diet helps promote regularity
of bowel movements, helps in of bowel movements, helps in regulating blood sugar, reducing regulating blood sugar, reducing cholesterol, may promote weight cholesterol, may promote weight loss, reduce risk of colon cancer & loss, reduce risk of colon cancer & diverticular diseasediverticular disease
Functions of CHO
Provide fuel (CHO primary source)Provide fuel (CHO primary source) Spare body protein (body can convert Spare body protein (body can convert
protein to glucose; body will break protein to glucose; body will break down internal protein stores before down internal protein stores before fat stores in absence of CHO)fat stores in absence of CHO)
Helps prevent ketosis (partially Helps prevent ketosis (partially broken down fats accumulate in blood broken down fats accumulate in blood as ketones)as ketones)
Enhance learning & memory Enhance learning & memory (Glucose)(Glucose)
Proteins
Provide a source of energyProvide a source of energy 4 kcal per gram4 kcal per gram Essential for synthesis of body tissue Essential for synthesis of body tissue
in growth, maintenance & repairin growth, maintenance & repair Collagen, hormones, enzymes, Collagen, hormones, enzymes,
immune cells, DNA, RNA are immune cells, DNA, RNA are composed of proteincomposed of protein
Blood clotting, fluid regulation, & Blood clotting, fluid regulation, & acid-base balance require proteinacid-base balance require protein
Protein Composed of carbon, hydrogen, Composed of carbon, hydrogen,
oxygen,& nitrogenoxygen,& nitrogen There are essential and There are essential and
nonessential amino acidsnonessential amino acids Complete and incomplete proteinsComplete and incomplete proteins Essential amino acids: isoleucine, Essential amino acids: isoleucine,
leucine, lysine, threonine, leucine, lysine, threonine, tryptophan, methionine, histidine, tryptophan, methionine, histidine, valine, phenylalaninevaline, phenylalanine
Protein
Albumin & Insulin are simple Albumin & Insulin are simple proteinsproteins
Lipoprotein is a complex protein Lipoprotein is a complex protein (Lipid & protein)(Lipid & protein)
Complete & Incomplete proteinsComplete & Incomplete proteins
Protein
Nitrogen balance- intake & output of Nitrogen balance- intake & output of nitrogen equalnitrogen equal
When intake of nitrogen exceeds When intake of nitrogen exceeds output, body is in a positive nitrogen output, body is in a positive nitrogen balance (growth, pregnancy, balance (growth, pregnancy, maintenance of lean muscle mass & maintenance of lean muscle mass & vital organs, wound healingvital organs, wound healing
The extra nitrogen is used for The extra nitrogen is used for building, repairing, & replacement of building, repairing, & replacement of tissuestissues
Protein
Negative Nitrogen balance- Body Negative Nitrogen balance- Body loses nitrogen faster than it gains itloses nitrogen faster than it gains it
Infection, Sepsis, Fever, starvation, Infection, Sepsis, Fever, starvation, head injury, trauma, burnshead injury, trauma, burns
Increased nitrogen loss is the result Increased nitrogen loss is the result of body tissue destruction or loss of of body tissue destruction or loss of nitrogen containing body fluidsnitrogen containing body fluids
How protein functions in the body
Provision of structureProvision of structure Growth & maintenance of tissueGrowth & maintenance of tissue Regulation of body processes Regulation of body processes
(hormones, enzymes, (hormones, enzymes, nucleoproteins)nucleoproteins)
Development of immunityDevelopment of immunity Circulation of blood and nutrientsCirculation of blood and nutrients Backup source of energyBackup source of energy
Fats
Fats(lipids) are the most calorically Fats(lipids) are the most calorically densedense
Composed of carbon, hydrogen, & Composed of carbon, hydrogen, & oxygen (basic structural oxygen (basic structural unit=glycerol)unit=glycerol)
9 kcal per gram9 kcal per gram Composed of monoglycerides, Composed of monoglycerides,
diglycerides, & triglyceridesdiglycerides, & triglycerides Lipogenesis- Synthesis of fatty acidsLipogenesis- Synthesis of fatty acids
Fats
Fatty acids can be Saturated or Fatty acids can be Saturated or Unsaturated, Monounsaturated, or Unsaturated, Monounsaturated, or polyunsaturated & Trans-fatty polyunsaturated & Trans-fatty acidsacids
Essential Fatty Acids (Linoleic, Essential Fatty Acids (Linoleic, Linolenic) must be supplied by dietLinolenic) must be supplied by diet
Nonessential fatty acidsNonessential fatty acids Necessary for metabolic processesNecessary for metabolic processes HDL vs LDLHDL vs LDL
Fats
Animal fats are high in saturated Animal fats are high in saturated fatty acidsfatty acids
Vegetable fats are high in Vegetable fats are high in unsaturated and polyunsaturated unsaturated and polyunsaturated fatty acidsfatty acids
Functions of Fats
Fuel sourceFuel source Vehicle for fat soluble vitaminsVehicle for fat soluble vitamins Satiety valueSatiety value Sources of essential fatty acidsSources of essential fatty acids Organ protectionOrgan protection LubricationLubrication InsulationInsulation Cell membrane structureCell membrane structure
Cholesterol
Not a true fat, classified as a sterolNot a true fat, classified as a sterol Body manufactures 1000 mg dayBody manufactures 1000 mg day Component of bile salts, essential Component of bile salts, essential
component of cell membrane, component of cell membrane, necessary for production of several necessary for production of several hormones (cortisone, estrogen hormones (cortisone, estrogen adrenaline, testosterone)adrenaline, testosterone)
Elevated blood levels is a major risk Elevated blood levels is a major risk factor for CAD ( < 200 mg/dL optimal)factor for CAD ( < 200 mg/dL optimal)
Water
Critical component of bodyCritical component of body Cell function depends on a fluid Cell function depends on a fluid
environmentenvironment 60-70% of body weight60-70% of body weight Muscle contains more water than fatMuscle contains more water than fat Infants have higher total body waterInfants have higher total body water Fluid needs met by ingesting fluids & Fluid needs met by ingesting fluids &
solid food high in water content solid food high in water content (fruits & veggies)(fruits & veggies)
Vitamins
Organic substances present in Organic substances present in small amounts in foodsmall amounts in food
Essential for normal metabolismEssential for normal metabolism Body depends on dietary intakeBody depends on dietary intake Vitamin content higher in fresh Vitamin content higher in fresh
foodsfoods Classification by solubility: water Classification by solubility: water
or fator fat
Vitamins
Fat Soluble- Vitamins A, D, E, KFat Soluble- Vitamins A, D, E, K Can be stored in bodyCan be stored in body Provided through dietary intake except for Provided through dietary intake except for
Vitamin DVitamin D Antioxidant role of vitaminsAntioxidant role of vitamins Water Soluble-Vitamin C, B Complex (8 Water Soluble-Vitamin C, B Complex (8
vitamins)vitamins) Cannot be stored in body, provided by Cannot be stored in body, provided by
dietary intakedietary intake Vitamins are catalysts in biochemical Vitamins are catalysts in biochemical
reactionsreactions
Functions of Fat-Soluble Vitamins
Vitamin A: vision, healthy epithelial Vitamin A: vision, healthy epithelial tissue, proper bone growth, energy tissue, proper bone growth, energy regulationregulation
Vitamin D: promotes normal bone Vitamin D: promotes normal bone mineralization, plays a role in calcium mineralization, plays a role in calcium and phosphorus absoprtionand phosphorus absoprtion
Vitamin E: antioxidant role (protects Vitamin E: antioxidant role (protects Vitamin A & unsaturated fatty acids from Vitamin A & unsaturated fatty acids from oxidationoxidation
Vitamin K: blood clotting, bone Vitamin K: blood clotting, bone metabolismmetabolism
Functions of Water-Soluble Vitamins
Vitamin C: collagen synthesis, Vitamin C: collagen synthesis, powerful antioxidant, adrenal powerful antioxidant, adrenal gland function, iron absorption, gland function, iron absorption, folic acid conversionfolic acid conversion
B-Complex: co-enzyme in B-Complex: co-enzyme in numerous metabolism numerous metabolism mechanismsmechanisms
Minerals
Inorganic elements essential to Inorganic elements essential to the body as catalysts in the body as catalysts in biochemical reactionsbiochemical reactions
Macrominerals-Body requires Macrominerals-Body requires 100mg or more100mg or more
Trace elements-Body needs less Trace elements-Body needs less than 100 mgthan 100 mg
Minerals
Macrominerals- Calcium, Sodium, Macrominerals- Calcium, Sodium, Potassium, Phosphorus, Potassium, Phosphorus, Magnesium, Sulfur, and ChlorideMagnesium, Sulfur, and Chloride
Trace Elements- Iodine, Fluoride, Trace Elements- Iodine, Fluoride, Iron, Selenium, Zinc, Copper, Iron, Selenium, Zinc, Copper, Selenium, Manganese, ChromiumSelenium, Manganese, Chromium
A & P of Digestion
Mechanical breakdown that results Mechanical breakdown that results from chewing, churning, mixing from chewing, churning, mixing with fluid, & chemical reaction till with fluid, & chemical reaction till food reaches it’s simplest formfood reaches it’s simplest form
Enzymes speed up chemical Enzymes speed up chemical reactionsreactions
A & P of Digestion
Dysphagia- Difficulty swallowingDysphagia- Difficulty swallowing Absorption occurs in small Absorption occurs in small
intestine- primary absorption site intestine- primary absorption site for nutrientsfor nutrients
Main source of water absorption Main source of water absorption via intestine, small intestine via intestine, small intestine reabsorbs 9.5 Lreabsorbs 9.5 L
Metabolism
Catabolism- Breakdown of Catabolism- Breakdown of biochemical substances into biochemical substances into simpler substances (starvation)simpler substances (starvation)
All body cells except RBC & All body cells except RBC & neurons can oxidize fatty acids neurons can oxidize fatty acids into ketones for energy in the into ketones for energy in the absence of dietary CHOabsence of dietary CHO
Metabolism
Biochemical reaction with cellsBiochemical reaction with cells Anabolic or CatabolicAnabolic or Catabolic Anabolism- Building of more Anabolism- Building of more
complex substances, occurs when complex substances, occurs when lean muscle is added through diet lean muscle is added through diet & exercise& exercise
Amino acids are anabolized into Amino acids are anabolized into tissue, hormones, & enzymestissue, hormones, & enzymes
Dietary Guidelines
Recommended dietary allowancesRecommended dietary allowances Food Guidelines-Food PyramidFood Guidelines-Food Pyramid Daily values on food labels (based Daily values on food labels (based
on 2000 kcal/day)on 2000 kcal/day)
Nutrition during Growth & Development
InfantInfant School AgeSchool Age AdolescentsAdolescents Young-Middle AdultsYoung-Middle Adults Older AdultsOlder Adults Alternative food patternsAlternative food patterns
Nursing Process & Nutrition
Assessment- AnthropometryAssessment- Anthropometry Body Mass IndexBody Mass Index Ideal Body WeightIdeal Body Weight Anthropometric measurementsAnthropometric measurements Labs- Albumin, Transferrin, Prealbumin, Labs- Albumin, Transferrin, Prealbumin,
Protein, Hgb, Total Lymphocyte CountProtein, Hgb, Total Lymphocyte Count Nitrogen balanceNitrogen balance Dietary & Health historyDietary & Health history Clinical ObservationClinical Observation
Nursing Diagnosis
You tell me!!!!!!You tell me!!!!!!
Conditions affecting Digestion
CVACVA GERDGERD Hiatal HerniaHiatal Hernia Gastric BypassGastric Bypass H-PyloriH-Pylori UlcersUlcers ObstructionObstruction GallbladderGallbladder
Malabsorption Malabsorption syndromessyndromes
Lactose IntoleranceLactose Intolerance Celiac diseaseCeliac disease IBSIBS IBD (colitis, Crohns)IBD (colitis, Crohns) DiverticulosisDiverticulosis Diarrhea/Diarrhea/
ConstipationConstipation HemorrhoidsHemorrhoids
ImplementationAcute Care
Oral delivery of nutrientsOral delivery of nutrients Enteral tube feedingsEnteral tube feedings Nasogastric, jejunal, gastric tubesNasogastric, jejunal, gastric tubes Less risk for aspiration with jejunal feedingsLess risk for aspiration with jejunal feedings Indicated in cancer of neck, upper GI tract, GI Indicated in cancer of neck, upper GI tract, GI
disorders, CVA, dementia, Inadequate oral disorders, CVA, dementia, Inadequate oral intakeintake
Parenteral NutritionParenteral Nutrition
Tube FeedingNsg Responsibilities
Document baseline weightDocument baseline weight Check Tube placementCheck Tube placement Check residual q 4 hrCheck residual q 4 hr Check labsCheck labs I & OI & O Daily weightDaily weight Aspiration PrecautionsAspiration Precautions Water FlushWater Flush Check for complicationsCheck for complications
Enteral Feeding Complications
Pulmonary aspirationPulmonary aspiration DiarrheaDiarrhea ConstipationConstipation Tube occlusionTube occlusion Tube displacementTube displacement Delayed gastric emptying (check Delayed gastric emptying (check
residual)residual) Nausea/vomiting/crampingNausea/vomiting/cramping
Enteral Feeding Formulas
OsmoliteOsmolite Perative Perative PulmocarePulmocare JevityJevity NeproNepro HepataidHepataid GlucernaGlucerna
Enteral Access
Nose-nasogastric (Levine, Dobhoff, Nose-nasogastric (Levine, Dobhoff, Flexiflo)Flexiflo)
Surgically placed- gastroscopy, Surgically placed- gastroscopy, jejunostomyjejunostomy
Endoscopically- Percutaneous Endoscopically- Percutaneous endoscopic gastroscopy (PEG)endoscopic gastroscopy (PEG)
Parenteral Nutrition
Specialized nutrition support in Specialized nutrition support in which nutrients are provided which nutrients are provided intravenouslyintravenously
Requires nutritional assessment, Requires nutritional assessment, placement of CV line, careful placement of CV line, careful monitoring for complicationsmonitoring for complications
Parenteral Nutrition
Clients who are unable to digest or Clients who are unable to digest or absorb enteral nutrition benefit absorb enteral nutrition benefit from TPN (Total parenteral from TPN (Total parenteral nutrition)nutrition)
Clients highly stressed Clients highly stressed physiologically (burns, sepsis, physiologically (burns, sepsis, head injury) also benefithead injury) also benefit
Parenteral Nutrition
Goal is to move back to GI routeGoal is to move back to GI route Adding lipids provides Adding lipids provides
supplemental kcals & provide supplemental kcals & provide essential fatty acidsessential fatty acids
10% - 20% Dextrose can be given 10% - 20% Dextrose can be given peripherally (PPN)peripherally (PPN)
>20% Dextrose requires CV line or >20% Dextrose requires CV line or PICC linePICC line
TPN Monitoring
Daily WeightDaily Weight BGM every 6 hoursBGM every 6 hours Vitals & temp every shiftVitals & temp every shift I & OI & O LabsLabs Dedicated line for infusionDedicated line for infusion
Nursing Implications
TPN intravenous line requires a filterTPN intravenous line requires a filter Dedicated line for infusionDedicated line for infusion IV tubing changed every 24 hoursIV tubing changed every 24 hours Requires IV pump administrationRequires IV pump administration Formulas prepared by pharmacist and Formulas prepared by pharmacist and
doubled checked by RNdoubled checked by RN Special physician order sheetSpecial physician order sheet 10% Dextrose solution used as substitute if 10% Dextrose solution used as substitute if
TPN not availableTPN not available
TPN Complications
Pneumothorax from CV line Pneumothorax from CV line insertioninsertion
Infection of CV lineInfection of CV line Air embolismAir embolism Lyte & mineral imbalancesLyte & mineral imbalances Concentrated glucose Concentrated glucose
administrationadministration
ImplementationPatient Education
Special diets may be necessary GI disorders-Special diets may be necessary GI disorders-Ulcer disease, IBD, Crohns, Malabsorption Ulcer disease, IBD, Crohns, Malabsorption Syndrome, Diverticulitis, Celiac diseaseSyndrome, Diverticulitis, Celiac disease
Diabetes (ADA diets)Diabetes (ADA diets) CV Disease & CVACV Disease & CVA Pulmonary DiseasePulmonary Disease Renal DiseaseRenal Disease CancerCancer HIVHIV
Usual Diet Progression
NPONPO Clear LiquidClear Liquid Full LiquidFull Liquid PureedPureed Mechanical softMechanical soft SoftSoft RegularRegular