lect24 nutrition

8/12/2019 Lect24 Nutrition

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Stressors that affect

Nutrition

NUR101

FALL 2008

LECTURE # 24

K. BURGER, MSED, MSN, RN, CNE

PPP By

Sharon Niggemeier RN MSN

Revised 12/08 J Borrero


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Nutrition

Nutrition is interaction between anorganism and the food it consumes

Food & eating is a basic need, affects

health Various factors affect nutrition

Nutrientssubstances used by the

body for growth & development Role of nurse to teach, guide and

inform on the importance of

proper nutrition


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Nursing Assessment

Dietary intake and food preparation

Unpleasant symptoms

Allergies

Taste, chewing and swallowing

Appetite and weight Use of medications


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Nutritional health-care Team

MD

Nurse

Social Worker

Physical Therapist

Occupational Therapist Speech Pathologist

Pharmacist


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Essential Nutrients Regulatory Nutrients

Water

Carbohydrates Proteins

Lipids

Vitamins

Minerals


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Water

Water: present in every cell

Absorbedin small /large intestine

Metabolizedcarbohydrates, proteins,lipids produce water

Dietary intake from fluids and solid

food provide water

Function: fluid medium needed for all

chemical reactions in the body


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Carbohydrates

Carbohydrates: simple or complex Digestedby enzymes

(amylase/lactase)

Absorbedin small intestine

Metabolizedinto glucose which is

used for energy or storedStored as

either glycogen or fat

Function: provide energy, spare

proteins


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Carbohydrates (CHO)

CarbonHydrogen-Oxygen

1 gram carbohydrate = 4 Kcal

Monosaccharidessimple sugars

glucose, fructose, galactose Dissaccharidesdouble sugars

sucrose, lactose, maltose

Polysaccharidescomplex forms

starch, glycogen, cellulose (fiber)

Recommended intake: 60% of total Kcal (300g)Fiber 25-30g daily


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Carbohydrates

What are some other functions of

carbohydrates in our bodies?

Laxative effects of:

Lactose

Cellulose

DIETARY FIBER -

Helps regulate blood

sugar

May reduce risk ofhyperlipidemia

May reduce risk of some

cancers


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Protein

Proteins: composed of amino acids Digestedby enzymes (proteolytic)

Absorbedin small intestine

Metabolismincludes:

Anabolism=Catabolism: Nitrogen

balance Function: maintain body

tissue and tissue growth


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Protein (CHON) Carbon-Hydrogen-Oxygen- Nitrogen

1 gram of protein = 4 Kcal

Comprised of 22 amino acids which can be comined by

body to form over 1000 types of proteins 9 essential amino acidsbody cannot synthesize them

Complete protein = one with all 9 essential amino acids(animal sources and soy)

Incomplete proteins = contain some but not all essential(plant sources)

Complementary proteins = 2 proteins that whencombined provide all essential amino acids.

Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)


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Lipids

Lipids: insoluble in water Digestedby enzymes (lipase,bile) in

stomach and small intestine

Absorbedin small intestine Metabolismincludes conversion (by

liver and small intestine) into soluble

compounds called lipoproteins Function: energy, insulates body,

absorption (fat-soluble vitamins)


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Lipids (Fats)

Carbon-Hydrogen-Oxygen

1 gram of Fat = 9 Kcal

Composed of fatty acids:(linoleic&linolenic =essential)

Saturated fat = mostly animal source

Unsaturated fat = mostly plant and fish sources

Triglyceride = fat in bloodstream /storage form of fat

in body.

Trans Fat = hydrogenated fats in processed foods

Recommended intake: 20-35% of total Kcal


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Lipids

Lipoproteins- made by the body to move water-insoluble lipids (such as cholesterol)thru the

bloodstream

LDL(low density lipoprotein)- major carrier of

cholesterol. Function is to transport cholesterolfrom liver into circulation. Bad cholesterol

HDL(High density lipoprotein) - carries

cholesterol away from tissue to liver ..high levelsdecrease atherosclerosis. Good cholesterol

Cholesterol- not essential from diet as the body

produces enough.


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Desirable Blood Lipid Levels

Total Cholesterol < 200

Triglycerides < 150

LDL < 100 HDL > 40 Male

> 50 Female

Elevated Blood Lipid Levels(Hyperlipidemia) = increased risk for CHD,Hypertension, Stroke, MI


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Vitamins Vitamins: required in small amounts

water- soluble: absorbed through

intestine directly into blood stream (C,B complex folic acid)

fat-soluble: absorbed with lipids into

lymphatic circulation (A,D,E,K)

Function: needed for metabolism of

carbohydrates, lipids & proteins


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Water-soluble vitamins text review

Vitamin C (ascorbic acid)

Function: collagen formation (wound

healing), antioxidant, immune system More prone to deficiency; not stored

Deficiency:bleeding gums, scurvy,

poor wound healing

Source: citrus fruits,

tomatoes, broccoli


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Vitamin B Complex : thiamine,

riboflavin, niacin, B6, B12 Function: metabolism of carbs, lipids

and proteins

RNA, DNA synthesis (folic acid) &heme formation (B12)

Deficiency:beriberi, poor wound

healing, anemia, pernicious anemia Sources:Whole grains

Organ meats


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Vitamin B12 (continued)

Vitamin B12 (cobalamine)

Important for hemoglobin synthesis

Very little found in vegetable sources (unlike other B Vitamins)

Pernicious anemia = B12 deficiency or lack of intrinsic

factor for B12 absorption.

Susceptible population = Total Vegan

Clients w/ decreased gastric acid secretion

(gastric bypass, stomach cancer)

Rx = B12 injections


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Folic Acid

Folic Acid (Folate)

Folic Acid Deficiency leads to elevated Homocysteinelevels which are associated with increased risk for CHD.

Folic Acid Deficiency linked to neural tube defectsSpina Bifida

Natural folate (in foods) only as available to body as

supplement folic acid 1998 = mandatory fortification of breads/grains

Supplements recommended for: women of child-bearingage, gastric surgery, malabsorption (alcholic)


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Fat-soluble Vitamins text review Vitamin A: function- visual acuity, skin

maintenancedeficiency-night blindnessDark green leafy vegs, yellow/orange vegs

Vitamin D: function-calcium absorption deficiency-rickets, bone malformation

Fortified milk, ultraviolet light Vitamin E: function-antioxidant, heme

synthesisdeficiency-RBC hemolysis

Whole grains, nuts

Vitamin K: function-formation blood clottingproteinsdeficiency- hemorrhage

Dark green leafy vegs, synthesized by bacteria in smintestine

More prone to toxicity; stored by body


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Minerals

Minerals: macrominerals or microminerals

Originate in earths crust, arent digested or

metabolized. Combine to form salts or organiccompounds. Always retain their chemical

properties.

Function: provide structure within the body(bones/teeth, F/E and acid /base balance, nerve

transmission, muscle contraction)


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Macrominerals text review Calcium: bone/ teeth formation, blood clotting,

nerve transmissiondeficiency-tetany,

osteoporosis

Phosphorous: bones, acid-base

balancedeficiency- muscle weakness

Magnesium:bones, metabolism ...deficiency-

muscle pain, poor cardiac function Potassium: f/e balance, acid-base balance

deficiency-muscle cramps , irregular ht. rate


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Energy Balance

Kilocalorie- unit of heat; measures theenergy in the diet

Basal metabolic rate (BMR)- amountof energy needed for all the

biochemical processes to occur when

the body is at rest. Proper nutrition provides the energy

needed to maintain health


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Body Weight Standards

Ideal bodyweight IBW =

balance ofenergy usedby the bodyand intake of

nutrients

Rule of thumbWomen: 100 lbs lst 5ft

5 lbs/inch over 5ftMen: 106 lbs lst 5 ft

6 lbs/inch over 5ft

Standardized chartsOverweight = 10% > chartObese = 20% > chart

Body mass index(BMI)18.524.9 healthy> 25 = overweight> 30 = obese> 40 = morbidly obese


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Calculate your BMI

Weight (lbs)

Height (inches) squared

X 705


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Factors Affecting Nutrition

Developmental

Gender

Ethnicity &culture

Food beliefs

Preference

Religion


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Factors Affecting Nutrition Lifestyle

Medications &

therapy Heath status

Advertising

AlcoholConsumption

Psychological

factors


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Adequate Nutrition Food Guide

Pyramid

Daily referenceintake

Food Labeling

Dietary guidelines


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Dietary Guidelines

Balance / Moderation / Variety

Maintain healthy weight

Exercise

Eat a variety of foods in moderation

Low sodium / Low fat / Low simple sugars

Alcohol in moderation


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Assessing: Nutrition

Nursing history

Physical exam

24-hr. recall

Food records

Anthropometic data Lab testsAlbumin & Prealbumin

HemoglobinTransferrin


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Nursing Dx

Imbalanced nutrition: less than body

requirements R/T NPO status AEB

height 56 wt 105 lbs., pt. states Ive never been this skinny before,

my clothes are hanging off of me

Impaired dentition R/T nutritionaldeficits AEB dentures not fitting

properly


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Planning- outcome criteria

Pt. will: Attain and maintain ideal body weight

Eat a variety of foods at each meal

Promote healthy nutritional practices


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Interventions

Monitoring food

intake Assist with

feeding

Stimulateappetite

Teaching


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Diet Restrictions

NPO Clear liquids-see

through (broth,apple juice)

Full liquidsfoodsthat turn to liquid atroom temp.

(shakes, milk) Softeasily chewed

and digested

Low residue- no seeds,raw vegetables orfruits, whole grains

High fiber- raw fruits,

grains, vegetables Sodium restricted:

Mild 2 gram Na/day

Moderate 1gram

Strict 500mg Severe 250 mg

DASH Dietary Approachesto Stop Hypertension


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Diet Restrictions

Calorie

restrictions

Diabetic diet

Cholesterol

Food

textures:Thick it

Thin

Nectar-like

Honey-like Spoon-thick


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Enteral Nutrition

Used when oral intake is inadequate,

swallowing difficulty, coma

Tube passed into gastrointestinal tract

to deliver nutrients Maintains GI integrity preferred over

parental feedings (via veins)


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Enteral Nutrition

Short term use

Nasogastric

Nasointestinal

Long term use

Gastrostomy Percutaneous

endoscopicgastrostromy(PEG)


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Enteral Formulas

Many types of formulas

Administered continuous orintermittent

Use pumps to monitor intake

Monitor Intake & Output


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Enteral Precautions

Prevent aspiration

Position fowlers/high fowlers

Assess placementcheck pH

Note residual

Auscultate bowel sounds


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Enteral Precautions

Preventing complications include:

Clogged tube Nasal erosion

Diarrhea

Infection

Dislodgement


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Parental Nutrition

Bypasses GI tract, nutritionadministered IV, more complicated

Total parental nutrition (TPN) alsocalled (hyperalimentation)centralline

Partial parental nutrition (PPN)..PICCline


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Evaluation

Use established outcomes to evaluate the

pts response to care

Pt understanding of therapeutic diet

Reassess S&S associated with altered

nutrition (wt, intake, lab results)

Determine pts satisfaction with nutritionaltherapy


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Summary

Nurses role, to understand nutrients andhow they affect nutrition

Various factors affect ones nutritionalstatus

Interventions include numerous diets,

assisting with feeding, monitoring andteaching

Nutrition can also be administered

lect24 nutrition

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