NEMCC Associate Degree Nursing
Nutrition Packet
Nutrient
Carbohydrates
(4 kcalories/gram)
Function
Fuel, spare protein,
prevent ketosis
Proteins
(4 kcalories/gram)
Complete/incomplete
Maintenance & growth,
regulate body processes,
immunity, energy
Fats
(9 kcalories/gram)
LDL, HDL, cholesterol
Terms: hydrogenation,
Fuel reserve, organ
protection, cell
membrane structure,
lubrication, insulation, fat
soluble vitamins
Fat Soluble Vitamins
A, D, E, K
Vitamin A.
Preformed
Provitamin A
(carotene)
Function
Deficiency/Toxicity
Excess intake above
body’s need stored as
fat
Source of nitrogen for
the body, excess
protein excreted by the
kidneys
Excess above needs
stored, in body
triglycerides, essential
fatty acid linoleic acid
Deficiency/Toxicity
Vision (rhodopsin),
maintenance of skin &
epithelium, normal bone
growth, energy
regulation
Deficiency –
xerophtalmia
Excess – carotenemia
Toxicity – HA, blurred,
vision, Inc. ICP, pain in
bones & joints, dry
skin, poor appetite
Vitamin D
Normal Bone
Mineralization
Vitamin E
Antioxidant, protects
lung against pollution,
stability of RBC
membrane
Deficiency – Rickets in
children, osteomalacia
in adults
Most toxic of all
vitamins, can lead to
death from Ca+ deposit
in brain, heart, kidney
Deficiency – sterility
Toxicity – supplemental
dose of >600 mg/day
for 1 year or longer
Vitamin K
Blood clotting, bone
metabolism
Deficiency – in
newborn due to sterile
bowel, Toxicity –
Sources
Fruits, cereal grain,
vegetables
Complete: meat,
poultry, fish, eggs, milk.
Incomplete: grains,
vegetables, nuts,
legumes, seeds.
Saturated – Animal
fats, solid at room
temp., coconut, palmkernel oils.
Polyunsaturated – corn
oil, safflower oil,
soybean oil.
Monosaturated – olive
& cannola
Sources
Sources: Preformedliver, kidney, egg yolk,
butter, cream, milk &
fortified milk products
Provitamin – carrots,
sweet potatoes,
squash, apricots,
cantaloupe, dark green
leafy (broccoli,
cabbage, etc.)
Sunshine –
manufactured in the
skin, Fortified milk.
Some health problems
interfere with
absorption.
Sources:
polyunsaturated fatty
acids (vegetables oils,
whole grains, wheat
germ, milk, eggs, fish,
meats, leafy vegetables
Cheese, milk, green
leafy vegetables.
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NEMCC Associate Degree Nursing
Nutrition Packet
excess dose causes
liver damage, bleeding,
hemolysis of RBC’s,
brain damage.
Water Soluble
Vitamins
Vitamin C
Function
Wound and Fx healing,
Antioxidant, Adrenal
gland function, Fe+
absorption, Folic acid
conversion
Deficiency/Toxicity
Sources
Deficiency – Scurvy
RDA – 60 mg/day.
Abruptly stopping
excessive intake will
cause rebound scurvy
Sources: citrus fruits,
tomatoes, white
potatoes, cabbage,
broccoli, turnip greens,
asparagus, berries,
melons
Thelma Rose Never Passes for B12 (Acronym for rest of the water soluble vitamins)
Thiamin (B1) RDA
Coenzyme in CHO
Deficiency – Wernicke- Pork, wheat germ,
increase with increased metabolism, metabolizes Korsakoff syndrome.
brewer’s yeast, beef,
CHO needs
alcohol to energy,
s/s – anorexia,
liver, legumes, eggs,
converts trytophan to
indigestion,
fish, enriched grains.
niacin
constipation, apathy,
fatigue, muscle
weakness, paralysis,
muscle atrophy, ?
cardiac failure/death.
Riboflavin
Coenzyme of protein
Deficiency –
Organ meats, milk,
metabolism.
ariboflavinosis s/s –
whole or enriched
lesions on lips & oral
grains, legumes,
cavity, seborrheic
vegetables.
dermatitis, scrotal or
vulval skin changes,
normocytic anemia,
Need ↑ as protein
need ↑.
Niacin
Coenzyme in production
Deficiency: pellagra “ 3 Preformed in meat,
Used to treat elevated
of energy from glucose.
D’s” – dermatitis,
also peanuts, legumes,
lipid levels
Synthesis of fatty acids,
diarrhea, dementia
coffee
body converts
Toxicity causes
tryptophan to niacin
flushing,
Pyridoxine (B6)
Co-enzyme of amino
Deficiency – unusual
Pork & organ meats
acids, converting
Toxicity – megadoses
best sources, otherstryptophan to niacin,
of 2 – 6 grams.
wheat germ, whole
antibodies, coenzyme for
grains. Not included in
neurotransmitters
enrichment.
Folate ( folic acid)
Formation of DNA,
Deficiency – common.
Liver, spinach,
Body has a 2 – 4 month formation of HEME
Results in impaired cell asparagus, broccoli,
store
division & protein
kidney beans, beets,
Alcohol, oral
synthesis, impaired
cabbage family,
contraceptives, ASA,
heme synthesis.
oranges, cantaloupe.
methotrexate interfere
Toxicity – rare
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NEMCC Associate Degree Nursing
Nutrition Packet
Vitamin B12
Stored in liver
Pharmaceutical name:
cyanocobalamin
Precursor to use of folic
acid in DNA replication,
Essential for RBC
manufacture, essential
for synthesis &
maintenance of myelin
Minerals
Calcium
Function
Muscle contractions and
relaxation, catalyst in
clotting, actives certain
enzymes, manufacture of
acetycholine
Phosphorum
Interrelated with Ca+ in
function & food sources,
component of bones,
teeth, RNA & DNA,
contained in ADP & ATP,
phospholipids, pH buffer
Maintain fld. Balance,
transmission of
electrochemical
impulses, adrenals
produce aldosterone
which regulates level.
2/3 in blood &
extracellular fluids, 1/3 in
bone
98% inside cells.
Necessary for conduction
of nerve impulses,
contraction of muscles,
maintain acid-base,
conversion of glucose to
glucogen
Sodium
Potassium
Deficiency – stomach
or intestinal disease,
diet, inadequate
intrinsic factor, ? due
to surgery or heredity.
S/S – numbness &
tingling in hands &
feet, RBC changes,
moodiness, confusion,
depression, delusion,
overt psychosis. ?
death.
Deficiency/Toxicity
Deficiency –
osteoporosis, tetany,
check Trousseau’s &
Chvostek’s.
Toxicity: due to
excessive intake,
hyperparathyroidism,
Vit D poisoning,
Deficiencyhyperparathyroidism
where too much Ca+,
along with phosphorus
withdrawn from bone,
Toxicity: unusual
Deficiency not
generally a problem
unless vomiting,
diarrhea, heavy
sweating, kidney
disease.
Toxicity – problem with
HTN, heart disease,
kidney disease.
Deficiency: due to
diarrhea, vomiting,
laxative abuse,
alkalosis, proteincalorie malnutrition.
Toxicity: can be fatal,
usually due to DKA,
kidney failure, adrenal
insufficiency, severe
dehydration,
destruction of cells by
Animals products –
meat milk, eggs,
cheese.
Sources
milk & milk products,
sardines, canned fish
such as salmon, beans,
cauliflower, rhubarb,
green leafy, beets,
broccoli. High fiber or
fat intake interferes in
absorption.
Widespread since
essential part of plant
& animal cells, animal
protein best source,
lean meats, nuts,
legumes
Table salt, milk & milk
products, lots in
processed foods (lunch
meats, white bread,
pickles, crackers,
chips),
butter, margarine
Present in all plant &
animal cells. Bananas,
dried fruits, oranges,
legumes, vegetables,
nuts, meats.
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NEMCC Associate Degree Nursing
Nutrition Packet
Magnesium
70% in bones, 30% in
tissues & body flds.
Nerve impulses, skeletal
muscle relaxation, bone
formation, holds Ca+ in
teeth, activates enzymes
for CHO, protein, fat
metabolism
Iron – when RBC’s
destroyed, Fe+ stored,
absorption increases
with increased need.
Heme iron in meat, fish
& poultry, nonheme
iron in plants (not as
absorbable)
HGB formation,
myoglobin, enzymes for
oxidation of glucose to
energy, stored as ferritin
in liver, spleen, bone
marrow
Iodine
Synthesis of thyroid
hormones
burns, crushing
injuries, severe
infection
Deficiency - ? due to
protein-calories
malabsorption ,
excessive vomiting,
diarrhea, diuretic tx.,
malabsorption, chronic
alcoholism. Impairs
CNS muscular
excitability, tetany,
disorientation,
convulsions, psychosis
Toxicity: lethargy,
sedation, hypotension,
bradycardia,
depression
respirations, ? resp or
cardiac arrest
Deficiency –
insufficient intake,
excessive blood loss,
malabsorption, lack of
hydrochloric acid.
Absorption affected by
alcohol, high Ca+
intake, Vitamin C, MFP,
decreased gastric acid.
Toxicity: overdose in
children, iron
metabolism disorders,
oversupply of
hemosiderin, chronic
alcoholism.
Deficiency – goiter
Toxicity – excess in
American diet, may
also cause goiter, skin
lesions
Widely distributed in
foods since part of the
chlorophyll molecule,
green vegetables,
legumes, shrimp, nuts,
fruits.
RDA 10 for men, 15
women
Liver, meats, eggs,
kidney beans, bran
cereal with raisins,
cream of wheat, lentils.
Fortified table salt,
saltwater fish, shellfish,
seaweed.
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NEMCC Associate Degree Nursing
Nutrition Packet
Diet Progression in the Hospital
NPO
Clear Liquid
Full Liquid
Pureed
Soft
Regular
Nothing to eat or drink, nothing by mouth
Broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices,
gelatin, popsicles
all above plus smooth textured dairy products, custards, refined
cooked cereals, vegetables juice, pureed vegetables, all fruit juices
All above plus scrambled eggs, pureed meats, vegetables, fruits,
mashed potatoes and gravy
All above plus ground or finely diced meats, flaked fish, cottage
cheese, cheese, rice, potatoes, pancakes, light breads, cooked
vegetables, cooked or canned fruits, bananas, soups, peanut butter
no restrictions on type or texture of food unless specified.
Types of Vegetarian Diets
Vegan
Lactovegetarian
Ovolactovegetarian
Plant products only (deficient in B12), Need vitamin supplement
Milk + vegetables (lacks iron & zinc)
Milk, eggs and vegetables.
Examples of Prescribed Diets*
Carbohydrate (CHO) Counting
High Fiber
Lactose-Restricted
Low Fat/Low cholesterol
Low sodium
Mechanical soft or
edentulous
Progressive
May be the diet ordered for diabetics. Certain high
carbohydrate food counts toward a total number of CHO for the
day. Many older diabetics may still be on the numbered calorie
ADA diets.
Whole grains, raw vegetables, fruits with peel such as apples,
etc. (need 25 g of fiber/day)
Lactose the carbohydrate in milk, if lactase deficiency, causes
bloating, loose stools, cramping. Teach to find other sources of
vitamins A, D, calcium.
Substitute poly- or mono-saturated fats for saturated fats, limit
total fat intake to no more than 30% of total calories, limit
cholesterol sources (eggs, milk, other animal products).
Limit processed foods (lunch meats, vegetables canned with
sodium), avoiding adding at table. Look for lower sodium items.
For those without teeth.
Begin with clear liquids and advance to regular as client
tolerates.
*Prescribed based on health status and diagnoses. Multiple diets may be prescribed (example: a
progressive, low-fat diet). These are examples, there are many more prescribed diets, plus cultural and
religious diets.
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NEMCC Associate Degree Nursing
Nutrition Packet
Food and Nutrition Guidelines
Food Group
Grains
Proteins
Fruits
Servings per
Day/Meal
Examples
Serving Sizes
Any food made from wheat, rice,
oats, cornmeal, barley, or
another cereal grain is a grain
product. Bread, pasta, breakfast
cereals, grits, and tortillas are
examples of grain products.
Foods such as popcorn, rice, and
oatmeal are also included. Grains
are divided into 2 subgroups:
Whole Grains and Refined Grains.
All foods made from seafood;
meat, poultry, and eggs; beans,
peas, and lentils; and nuts, seeds,
and soy products are part of the
Protein Foods Group. Beans,
peas, and lentils are also part of
the Vegetable Group.
1 slice of bread,
1 cup of readyto-eat cereal, or
½ cup of cooked
rice/pasta/cereal
is equal to 1
serving.
3 to 5
ounces/equivalent
per day. Half of
grains should be
whole grains.
In general, 1
ounce of meat,
poultry or fish, ¼
cup cooked
beans, 1 egg, 1
tablespoon of
peanut butter,
or ½ ounce of
nuts or seeds
can be
considered as 1
ounceequivalent from
the Protein
Foods Group.
4 oz of protein
(size of hand) is
equal to 1
serving.
Fruit the size of a
5 to 7
ounces/equivalent
per day
Any fruit or 100% fruit juice
1 ½ to 2 ½ cups per
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NEMCC Associate Degree Nursing
Nutrition Packet
Vegetables
Dairy
counts as part of the Fruit Group.
Fruits may be fresh, frozen,
canned, or dried/dehydrated, and
may be whole, cut-up, pureed, or
cooked.
tennis ball, 1 cup
of fruit or 100%
juice, or ½ cup of
dried fruit is
equal to 1
serving.
Any vegetable or 100% vegetable
juice counts as part of the
Vegetable Group. Vegetables may
be raw or cooked; fresh, frozen,
canned, or dried/dehydrated; and
may be whole, cut-up, or
mashed. Based on their nutrient
content, vegetables are organized
into 5 subgroups: dark green; red
and orange; beans, peas, and
lentils; starchy; and other
vegetables.
Animal milk, soy milk, yogurt,
natural cheeses. Low-fat or fatfree versions recommended.
1 cup of raw or
cooked
vegetables or
100% vegetable
juice, 2 cups of
raw, leafy salad
greens is equal
to 1 serving.
Fats/Oils/Sweets Oils are fats that are liquid at
room temperature (examples
include fish oil, avocado oil, olive
oil). Solid fats are solid at room
temperature (examples include
butter, lard, and shortening).
day. Half of each
plate should be
fruits and
vegetables. At least
half of the
recommended
amount of fruit
should come from
whole fruit, rather
than 100% fruit
juice.
2 to 4 cups per day.
Half of each plate
should be fruits and
vegetables.
In general, 1 cup
of milk, yogurt,
or soy milk, or 1
½ ounces of
natural cheese
can be
considered as 1
serving from the
Dairy Group.
2 to 3 servings per
day
Use sparingly
Use sparingly
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NEMCC Associate Degree Nursing
Nutrition Packet
How to Calculate BMI
(page 1112 in Fundamentals book)
1. Calculate BMI with Imperial/English Measurements (lbs/ft/in):
BMI = 703 x Body Weight (lbs) / [height(in)]2
Example: Pt weighs 130lbs and is 5 ft and 10 inches tall
BMI = 703 x 130 / (70in)2
BMI = 91650/4900
BMI = 18.7
Or…
2. Calculate BMI with Metric System Measurements (kg/cm/m):
BMI = Body weight (kg) / [height (m)]2
Example: Pt weighs 130lbs and is 5 ft and 10 inches tall
BMI = 59 kg/(177.8cm)2
BMI = 59 kg/(1.778m)2
BMI = 59kg/3.16m
BMI = 18.7
Important Conversions:
• 1 kg = 2.2 lbs
• 1 in = 2.54 cm
• 100cm = 1 m
BMI Categories:
• <19.8 = underweight or low
• 19.8 – 26.0 = normal
• 26.0 – 29.0 = overweight or high
• >29.0 = obese
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