focus on nutrition (relates to chapter 40, “nursing management: nutritional problems,” in the...

Focus on NutritionFocus on Nutrition

(Relates to Chapter 40, (Relates to Chapter 40, “Nursing Management: Nutritional “Nursing Management: Nutritional

Problems,” Problems,” in the textbook)in the textbook)

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Normal NutritionNormal Nutrition

•Process in which the body Process in which the body uses food for energy, uses food for energy, growth, and maintenance growth, and maintenance and repair of tissuesand repair of tissues

•USDA—MyPyramid with USDA—MyPyramid with guidelines for healthy dietguidelines for healthy diet


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• Essential components of Essential components of basic food groups basic food groups CarbohydratesCarbohydrates FatsFats ProteinsProteins VitaminsVitamins MineralsMinerals


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Food PyramidFood Pyramid


Fig. 40-1. In the MyPyramid, each food group is characterized by varying widths, representative of the proportion of each group that should be eaten. The person climbing the stairs on the side of the pyramid indicates the need to include daily physical activity in a healthy lifestyle.

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• Carbohydrates Carbohydrates Are primary source of energyAre primary source of energy

•4 kcal/gram Chief protein-sparing ingredientChief protein-sparing ingredient Compose 45% to 65% of daily Compose 45% to 65% of daily

caloric needs caloric needs Simple versus complexSimple versus complex

•Monosaccharides (simple)•Disaccharides (simple)•Polysaccharides (complex)


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•Monosaccharides (simple)Monosaccharides (simple) GlucoseGlucose Fructose Fructose Found in fruits and honeyFound in fruits and honey


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•Disaccharides (simple)Disaccharides (simple) SucroseSucrose MaltoseMaltose LactoseLactose GlucoseGlucose Fructose Fructose Found in table sugar, malted Found in table sugar, malted

cereal, milkcereal, milk


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•Complex carbohydrates Complex carbohydrates (polysaccharides)(polysaccharides) Starches such as cereal Starches such as cereal

grains, potatoes, and grains, potatoes, and legumeslegumes


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• FatsFats Major source of energy Major source of energy Source of insulationSource of insulation Carriers of essential fatty Carriers of essential fatty

acids and fat-soluble vitaminsacids and fat-soluble vitamins 20% to 35% of total daily 20% to 35% of total daily

caloric intakecaloric intake 9 kcal/gram9 kcal/gram


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•ProteinsProteins Essential for tissue growth, Essential for tissue growth,

repair, and maintenancerepair, and maintenance Body regulatory functionsBody regulatory functions Energy productionEnergy production


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Normal NutritionNormal Nutrition•Proteins Proteins

Complex nitrogenous organic Complex nitrogenous organic compounds consisting of amino compounds consisting of amino acidsacids

Obtained from animal and plant Obtained from animal and plant sourcessources

4 kcal/gram4 kcal/gram 10% to 35% of daily caloric needs10% to 35% of daily caloric needs Essential versus nonessential Essential versus nonessential

amino acidsamino acids


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• Essential amino acidsEssential amino acids Amino acids that must come Amino acids that must come

from dietary sourcesfrom dietary sources Complete vs. incompleteComplete vs. incomplete

•Complete: Contain all essential amino acids (milk, eggs, meats)

•Incomplete: Lack one or more essential amino acids (grains, nuts, seeds, legumes)


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•Nonessential amino acidsNonessential amino acids Body can synthesize if Body can synthesize if

protein is available.protein is available.


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•Vitamins Vitamins Organic compounds required in Organic compounds required in

small amounts for normal small amounts for normal metabolism metabolism

Function primarily in enzyme Function primarily in enzyme reactionsreactions

Water soluble vs. fat solubleWater soluble vs. fat soluble•Water soluble (vitamin C and B-complex)

•Fat soluble (vitamins A, D, E, K)


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•Mineral saltsMineral salts Magnesium, iron, calcium make Magnesium, iron, calcium make

up 4% of total body weight.up 4% of total body weight. Necessary for building tissuesNecessary for building tissues Regulation of body fluidsRegulation of body fluids Assist in various body functionsAssist in various body functions Can be toxic in excessive Can be toxic in excessive

amountsamounts Major and traceMajor and trace


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Major MineralsMajor Minerals

•CalciumCalcium•ChlorideChloride•MagnesiumMagnesium•PhosphorusPhosphorus•PotassiumPotassium•SodiumSodium•Sulfur Sulfur


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Special DietsSpecial Diets

•VegetarianVegetarian Common element is exclusion Common element is exclusion

of red meat from diet.of red meat from diet. Well-planned diets needed to Well-planned diets needed to

avoid deficienciesavoid deficiencies Various reasons for followingVarious reasons for following

•Religious•Cultural


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•VegansVegans Eat only plant foodsEat only plant foods Lack of cobalamin (vitamin BLack of cobalamin (vitamin B1212) )

common common Can develop megaloblastic anemia Can develop megaloblastic anemia

and neurologic symptoms of and neurologic symptoms of deficiencydeficiency

Other possible deficiencies Other possible deficiencies •Calcium, zinc, vitamins A and D, protein, iron


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• Lacto-ovo vegetariansLacto-ovo vegetarians Eat plant foods and Eat plant foods and

sometimes dairy products sometimes dairy products and eggsand eggs

Watch for vitamin and Watch for vitamin and mineral deficiencies mineral deficiencies •Iron deficiencyIron deficiency


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Cultural CareCultural Care

•Nurse shouldNurse should Include cultural/ethnic Include cultural/ethnic

considerations considerations •Dietary choices (traditional foods)•Weight maintenance

Avoid cultural stereotypingAvoid cultural stereotyping Teach dietary Teach dietary

restrictions/changes to entire restrictions/changes to entire familyfamily


For which of the following patients is it most important For which of the following patients is it most important for the nurse to refer to the dietitian for a complete for the nurse to refer to the dietitian for a complete nutritional assessment?nutritional assessment?

1. A 38-year-old diabetic who is undergoing laser eye 1. A 38-year-old diabetic who is undergoing laser eye surgerysurgery2. A 55-year-old with a history of alcoholism who is 2. A 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall hospitalized with a fractured femur resulting from a fall 3. A 24-year-old who has been taking a burst of 3. A 24-year-old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an corticosteroid therapy for 1 week for treatment of an asthma exacerbationasthma exacerbation4. A 45-year-old hospitalized with nausea and 4. A 45-year-old hospitalized with nausea and abdominal pain who has had no oral intake and has abdominal pain who has had no oral intake and has received only IV fluids of D5½NS for 6 daysreceived only IV fluids of D5½NS for 6 days

Audience Response Question

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

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• 21-year-old woman comes 21-year-old woman comes into her physician’s office for into her physician’s office for her routine check-up. her routine check-up.

•She states that she has She states that she has switched to a vegetarian diet switched to a vegetarian diet because she is concerned because she is concerned with cruelty to animals.with cruelty to animals.


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•She eats mainly fast food and She eats mainly fast food and salads from her college salads from her college cafeteria.cafeteria.

•She consumes milk, eggs, and She consumes milk, eggs, and cheese.cheese.

•No abnormalities are noted on No abnormalities are noted on assessment.assessment.


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Discussion QuestionsDiscussion Questions

1.1.What deficiency might her What deficiency might her diet include?diet include?

2.2.What foods would you What foods would you stress to compensate for stress to compensate for the lack of meat?the lack of meat?


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Discussion QuestionsDiscussion Questions

3.3. What resources could you What resources could you recommend to help her recommend to help her learn more about a learn more about a vegetarian’s needs?vegetarian’s needs?


focus on nutrition (relates to chapter 40, “nursing management: nutritional problems,” in the...

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