Basic Human Needs
Nutrition
Nutrients: The Biochemical
units of nutrition
Body requires fuel to provide energy
for cellular metabolism and repair,
organ function, growth & body
movement
 Food is the fuel that keeps the machine
that is our body running
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Energy requirements based
on:
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Basal metabolic rate (BMR)-Energy needed to
maintain life sustaining ( Breathing, circulation,
temperature, heart rate)
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Resting Energy Expenditure (REE)-measurement that
accounts for BMR plus energy needed to digest food
& perform mild activity. Accounts for 60-70% of our
daily needs
Nutrients
Elements necessary for body processes
& function
 6 Categories
 Carbohydrates, Proteins, Fats, Water,
Vitamins, Minerals
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Carbohydrates
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Main source of energy (55-60% of calories in
diet)
Each gram = 4 kcal
Composed of carbon, hydrogen & oxygen
Main source of fuel (glucose) for brain,
skeletal muscle during exercise, RBC &WBC
production, cell function of renal medulla
Obtained from plant foods, except for lactose
(milk, sugar)
Simple Carbohydrates
Classified according to saccharides
 Monosaccharide- glucose(dextrose),
fructose, galactose (building blocks of
all other CHO)
 Glucose- blood sugar (normal fasting
BS=70-100 mg/ml)
 Disaccharide- sucrose, lactose, maltose,
 Sugar alcohols-sugar replacers
 Artificial sweetners
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Complex Carbohydrates
Polysaccharides are complex
carbohydrates
 Starches, glycogen, & fiber are
polysaccharides
 Starches are the major source of CHO
in diet (grains, cereals, breads, pasta,
starchy vegetables & legumes)
 Glycogen- animal starch (found in liver
& muscle tissue, provides immediate
fuel for muscle action
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Dietary Fiber
Plant foods that cannot be broken
down by body to digest
 Fiber eliminated by intestinal waste
 Adds volume, no fuel or energy
 Fiber in diet helps promote regularity
of bowel movements, helps in
regulating blood sugar, reducing
cholesterol, may promote weight loss,
reduce risk of colon cancer &
diverticular disease
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Functions of CHO
Provide fuel (CHO primary source)
 Spare body protein (body can convert
protein to glucose; body will break
down internal protein stores before fat
stores in absence of CHO)
 Helps prevent ketosis (partially broken
down fats accumulate in blood as
ketones)
 Enhance learning & memory (Glucose)
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Proteins
Provide a source of energy
 4 kcal per gram
 Essential for synthesis of body tissue in
growth, maintenance & repair
 Collagen, hormones, enzymes, immune
cells, DNA, RNA are composed of
protein
 Blood clotting, fluid regulation, & acidbase balance require protein
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Protein
Composed of carbon, hydrogen,
oxygen,& nitrogen
 There are essential and nonessential
amino acids
 Complete and incomplete proteins
 Essential amino acids: isoleucine,
leucine, lysine, threonine, tryptophan,
methionine, histidine, valine,
phenylalanine
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Protein
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Albumin & Insulin are simple proteins
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Lipoprotein is a complex protein (Lipid
& protein)
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Complete & Incomplete proteins
Protein
Nitrogen balance- intake & output of
nitrogen equal
 When intake of nitrogen exceeds
output, body is in a positive nitrogen
balance (growth, pregnancy,
maintenance of lean muscle mass &
vital organs, wound healing
 The extra nitrogen is used for building,
repairing, & replacement of tissues
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Protein
Negative Nitrogen balance- Body loses
nitrogen faster than it gains it
 Infection, Sepsis, Fever, starvation,
head injury, trauma, burns
 Increased nitrogen loss is the result of
body tissue destruction or loss of
nitrogen containing body fluids
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How protein functions in the
body
Provision of structure
 Growth & maintenance of tissue
 Regulation of body processes
(hormones, enzymes, nucleoproteins)
 Development of immunity
 Circulation of blood and nutrients
 Backup source of energy
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Fats
Fats(lipids) are the most calorically
dense
 Composed of carbon, hydrogen, &
oxygen (basic structural unit=glycerol)
 9 kcal per gram
 Composed of monoglycerides,
diglycerides, & triglycerides
 Lipogenesis- Synthesis of fatty acids
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Fats
Fatty acids can be Saturated or
Unsaturated, Monounsaturated, or
polyunsaturated & Trans-fatty acids
 Essential Fatty Acids (Linoleic,
Linolenic) must be supplied by diet
 Nonessential fatty acids
 Necessary for metabolic processes
 HDL vs LDL
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Fats
Animal fats are high in saturated fatty
acids
 Vegetable fats are high in unsaturated
and polyunsaturated fatty acids
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Functions of Fats
Fuel source
 Vehicle for fat soluble vitamins
 Satiety value
 Sources of essential fatty acids
 Organ protection
 Lubrication
 Insulation
 Cell membrane structure
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Cholesterol
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Not a true fat, classified as a sterol
Body manufactures 1000 mg day
Component of bile salts, essential component
of cell membrane, necessary for production
of several hormones (cortisone, estrogen
adrenaline, testosterone)
Elevated blood levels is a major risk factor
for CAD ( < 200 mg/dL optimal)
HDL vs LDL
Water
Critical component of body
 Cell function depends on a fluid
environment
 60-70% of body weight
 Muscle contains more water than fat
 Infants have higher total body water
 Fluid needs met by ingesting fluids &
solid food high in water content (fruits
& veggies)
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Vitamins
Organic substances present in small
amounts in food
 Essential for normal metabolism
 Body depends on dietary intake
 Vitamin content higher in fresh foods
 Classification by solubility: water or fat
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Vitamins
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Fat Soluble- Vitamins A, D, E, K
Can be stored in body
Provided through dietary intake except for
Vitamin D
Antioxidant role of vitamins
Water Soluble-Vitamin C, B Complex (8
vitamins)
Cannot be stored in body, provided by
dietary intake
Vitamins are catalysts in biochemical
reactions
Functions of Fat-Soluble
Vitamins
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Vitamin A: vision, healthy epithelial tissue,
proper bone growth, energy regulation
Vitamin D: promotes normal bone
mineralization, plays a role in calcium and
phosphorus absoprtion
Vitamin E: antioxidant role (protects Vitamin
A & unsaturated fatty acids from oxidation
Vitamin K: blood clotting, bone metabolism
Functions of Water-Soluble
Vitamins
Vitamin C: collagen synthesis, powerful
antioxidant, adrenal gland function,
iron absorption, folic acid conversion
 B-Complex: co-enzyme in numerous
metabolism mechanisms
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Minerals
Inorganic elements essential to the
body as catalysts in biochemical
reactions
 Macrominerals-Body requires 100mg or
more
 Trace elements-Body needs less than
100 mg
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Minerals
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Macrominerals- Calcium, Sodium,
Potassium, Phosphorus, Magnesium,
Sulfur, and Chloride
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Trace Elements- Iodine, Fluoride, Iron,
Selenium, Zinc, Copper, Selenium,
Manganese, Chromium
A & P of Digestion
Mechanical breakdown that results
from chewing, churning, mixing with
fluid, & chemical reaction till food
reaches it’s simplest form
 Enzymes speed up chemical reactions
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A & P of Digestion
Dysphagia- Difficulty swallowing
 Absorption occurs in small intestineprimary absorption site for nutrients
 Main source of water absorption via
intestine, small intestine reabsorbs
9.5 L
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Metabolism
Catabolism- Breakdown of biochemical
substances into simpler substances
(starvation)
 All body cells except RBC & neurons
can oxidize fatty acids into ketones for
energy in the absence of dietary CHO
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Metabolism
Biochemical reaction with cells
 Anabolic or Catabolic
 Anabolism- Building of more complex
substances, occurs when lean muscle is
added through diet & exercise
 Amino acids are anabolized into tissue,
hormones, & enzymes
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Dietary Guidelines
Recommended dietary allowances
 Food Guidelines-Food Pyramid
 Daily values on food labels (based on
2000 kcal/day)
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Nutrition during Growth &
Development
Infant
 School Age
 Adolescents
 Young-Middle Adults
 Older Adults
 Alternative food patterns
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Cultural Aspects of Nutrition
Hot Foods
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Hot foods: Rice, grain cereals, alcohol,
beef, lamb, chili peppers, chocolate,
cheese, eggs, peas, goats milk
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Conditions that require “hot” foods:
Menstruation, cancer, pneumonia,
earache, colds, headache
Cultural Aspects of Nutrition
Cold Foods
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Cold foods: Beans, citrus fruits, tropical
fruits, dairy products, honey, chicken,
fish and goat
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Conditions that require cold foods:
Pregnancy, fever, infections, diarrhea,
rashes, liver problems, constipation,
sore throats
Nursing Process & Nutrition
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Assessment- Anthropometry
Body Mass Index
Ideal Body Weight
Anthropometric measurements
Labs- Albumin, Transferrin, Prealbumin, Protein,
Hgb, Total Lymphocyte Count
Nitrogen balance
Dietary & Health history
Clinical Observation
Nursing Diagnosis
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You tell me!!!!!!
Conditions affecting Digestion
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CVA
GERD
Hiatal Hernia
Gastric Bypass
H-Pylori
Ulcers
Obstruction
Gallbladder
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Malabsorption
syndromes
Lactose Intolerance
Celiac disease
IBS
IBD (colitis, Crohns)
Diverticulosis
Diarrhea/Constipation
Hemorrhoids
Implementation
Acute Care
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Oral delivery of nutrients
Enteral tube feedings
Nasogastric, jejunal, gastric tubes
Less risk for aspiration with jejunal feedings
Indicated in cancer of neck & upper GI tract, GI
disorders, CVA, dementia, inadequate oral intake,
respiratory failure with prolonged intubation
Parenteral Nutrition: Indicated in conditions with
nonfunctioning GI tract, extended bowel rest,
Tube Feeding
Nsg Responsibilities
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Document baseline weight
Check Tube placement
Check residual q 4 hr
Check labs
I&O
Daily weight
Aspiration Precautions
Water Flush
Check for complications
Enteral Feeding Complications
Pulmonary aspiration
 Diarrhea
 Constipation
 Tube occlusion
 Tube displacement
 Delayed gastric emptying (check
residual)
 Nausea/vomiting/cramping
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Aspiration Precautions
Elevate HOB > 30 degrees
 Good oral care
 Regular assessment of feeding
tolerance
 Prokinetic medications (Reglan)
 Regular assessment of tube placement
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X-ray most accurate
 Mark tube (NGT/OGT) at exit site with
indelible ink or tape. (AACN, 2005)
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Enteral Feeding Formulas
Osmolite
 Perative
 Pulmocare
 Jevity
 Nepro
 Hepataid
 Glucerna
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Enteral Access
Nose-nasogastric (Levine, Dobhoff,
Flexiflo)
 Surgically placed- gastroscopy,
jejunostomy
 Endoscopically- Percutaneous
endoscopic gastroscopy (PEG)
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Parenteral Nutrition
Specialized nutrition support in which
nutrients are provided intravenously
 Requires nutritional assessment,
placement of CV line, careful
monitoring for complications
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Parenteral Nutrition
Clients who are unable to digest or
absorb enteral nutrition benefit from
TPN (Total parenteral nutrition)
 Clients highly stressed physiologically
(burns, sepsis, head injury) also benefit
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Parenteral Nutrition
Goal is to move back to GI route
 Adding lipids provides supplemental
kcals & provide essential fatty acids
 10% - 20% Dextrose can be given
peripherally (PPN)
 >20% Dextrose requires CV line or
PICC line
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TPN Monitoring
Daily Weight
 BGM every 6 hours
 Vitals & temp every shift
I & O
 Labs
 Dedicated line for infusion
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Nursing Implications
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TPN intravenous line requires a filter
Dedicated line for infusion
IV tubing changed every 24 hours
Requires IV pump administration
Formulas prepared by pharmacist and doubled
checked by RN
Special physician order sheet
10% Dextrose solution used as substitute if TPN not
available
TPN Complications
Pneumothorax from CV line insertion
 Infection of CV line
 Air embolism
 Lyte & mineral imbalances
 Concentrated glucose administration
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Implementation
Patient Education
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Special diets may be necessary GI disorders-Ulcer
disease, IBD, Crohns, Malabsorption Syndrome,
Diverticulitis, Celiac disease
Diabetes (ADA diets)
CV Disease & CVA
Pulmonary Disease
Renal Disease
Cancer
HIV
Usual Diet Progression
NPO
 Clear Liquid
 Full Liquid
 Pureed
 Mechanical soft
 Soft
 Regular
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