Nutrition NURS 4935A Fundamentals of Nursing Goldfarb School of Nursing Prof. A. Painter MSN, RN Sources of Nutrition ATI Chapter 1 Carbohydrates and fiber Proteins Lipids Vitamins Water-soluble Fat-soluble Minerals and Electrolytes Water Phytonutrients Carbohydrates Organic compounds composed of carbon, hydrogen, and oxygen (CHO) Types Monosaccharides Disaccharides Polysaccharides Considerations The liver converts fructose and galactose into glucose The body digests 95% of starch within 1-4 hours Glycogen is the stored CHO energy source found in liver Digestible CHO provides 4cal/g of energy Proteins Two types Complete Animal sources and soy Incomplete From plant sources Considerations Metabolic functions Three factors influence bodies requirement Recommended 0.8g/kg for adults or 10-30% of total calories Provides 4 cal/g of energy Lipids Chemical group of fats = Lipids Sources Dark meat Poultry skin Dairy foods Added oils (butter, margarine, shortening, oils, lard) Essential nutrient Used for energy Three types Triglycerides Phospholipids Sterols Considerations 20-35% of total calories Provide 9 cal/g of energy Vitamins Organic substances required for enzymatic reactions 13 essential vitamins Two classes Water-soluble C and B-complex (8 of them) Fat-soluble A, D, E and K Toxicity could occur with any fat soluble vitamin Minerals and Electrolytes Minerals -Inorganic elements and available in food sources Electrolytes – electrically charged minerals that cause physiological reactions that maintain homeostasis Major Minerals Sodium Potassium Calcium Phosphorus Magnesium Chloride Sulfur Trace Iodine Iron Fluoride Water Most basic nutrient Intake requirements 2.7 L/day - Females (2.2 L/day from fluids) 3.7 L/day - Males (3 L/day from fluids) Ingestion, Digestion, Absorption and Metabolism ATI Chapter 2 Ingestion- Process of consuming food Digestion- Process of breaking down food Absorption- nutrients move to blood stream Metabolism- sum of all chemical processes Catabolism- breaking down substances to release energy Anabolism – use of energy to build or repair Basal Metabolic Rate (BMR) Increase BMR Lean, muscular build Exposure to extreme temperatures Prolonged stress Rapid growth periods Pregnancy lactation Physical conditioning Conditions Fever Tremors Hyperthyroidism Cardiac failure Burns Surgery/wound healing Cancer Medications Epinephrine Levothyroxine Ephedrine sulfate Decrease BMR Short, overweight body build Starvation/malnutrition Age related loss of lean body masses Conditions Hypothyroidism Medications Opioids Muscle relaxants Barbiturates Nitrogen Balance in Nutrition Positive nitrogen balance – intake of nitrogen exceeds output of nitrogen required for growth, pregnancy, maintenance of lean muscle and vital organs, wound healing. Negative nitrogen balance body loses more nitrogen than the body gains infection, sepsis, burns, fever, starvation, head injuries, and trauma A negative Nitrogen Balance must be reversed for healing to occur. Nutritional Assessment ATI Chapter 3 Screening a patient is a quick method of identifying malnutrition or risk of malnutrition using sample tools: Height Weight Weight change % weight change= 𝑈𝑠𝑢𝑎𝑙 𝑤𝑒𝑖𝑔ℎ𝑡 −𝑐𝑢𝑟𝑟𝑒𝑛𝑡 𝑤𝑒𝑖𝑔ℎ𝑡 𝑈𝑠𝑢𝑎𝑙 𝑤𝑒𝑖𝑔ℎ𝑡 x 100 BMI Nutritional Assessment Ideal Body Wt (IBW)- pounds based on ht. BMI=Wt (kg) Ht (m2) Underweight Below 18.5 Normal 18.5–24.9 Overweight 25.0–29.9 Obesity 30.0 and Above Lab Values associated with nutrition status Albumin (21 days)—better indicator for chronic disease (3.5-5.0 g/L) Prealbumin (2 days)—better indicator for acute illnesses (16-35 mg/dL) Total Protein (6.0 – 8.0 g/dL) Blood Glucose (70-110 mg/dL) Nutritional Guidelines Healthy People 2020; Health for All (WHO) Guidelines for dietary change recommend reduced fat, saturated fat, sodium, refined sugar, and cholesterol, and increased intake of complex carbohydrates and fiber. ATI Nutrition book Chapter 4 Heart Health and Foods Limit saturated fats to 10% of total calories DASH diet (Dietary Approaches to Stop Hypertension) Nervous System B-Complex vitamins Calcium Bones Calcium, magnesium, and phosphorus Weight bearing activities Bowel Function Fiber Fruit, vegetable, and grains Cancer Well balanced diet High-fiber plant-based foods Limit sodium Avoid excess alcohol intake Regular exercise Food Safety ATI Chapter 5 Conscious, with intact gag or swallow reflex Risk of aspiration Stroke patients Anesthesia of esophagus Very young children Food Safety Storage Fresh meat Refrigerated at 40º F or colder Bacon Sausage Summer sausage Steaks, chops, roasts Chicken or Turkey Fish Eggs Fruits and Veggies Perishables Canned Goods Foodborne Illness Greatest risk to elderly, young children, pregnant, and immunocompromised Bacteria – majority of deaths Salmonella Escherichia coli Listeria Monocytogenes Virus – cause majority of illnesses Norovirus Allergies Dysphagia Difficulty when swallowing Signs include: Coughing when eating Change in voice tone after swallowing Abnormal movements of mouth or tongue Incomplete oral clearance Regurgitation Inability to speak consistently Silent Aspiration Religious Influences ATI Chapter 6 Eating on Holy days Feasts or special diets Fasting for religious holidays Islam, Roman Catholics, Seventh-Day Adventism Restricting Specific substances Alcohol, pork, coffee or tea, food not consumed at same time Consuming animal products Seventh-Day Advents – vegetarian Judaism and Islam – Kosher animals Preparing foods Orthodox Judaism – cannot prepare food on sabbath Cultural Influences Hispanic/Latinx Certain food are considered hot or cold Used to provide balance for healing African American Food habits related to personal factors (work, location) Asian American Use more rice and vegetables Believe in yin and yang forces Nutrition across Lifespan ATI Chapter 7 Pregnancy and Lactation Good nutrition essential to for health of baby Nutritional demands increased during pregnancy Infancy Birth weight doubles by 4 to 6 months Introduce solid food one at a time. Childhood Grow 2-3 inches and 5-6 lbs. / year Adolescents 2,000 cal/day for 12–18-year-old female 2,200 – 2,800 cal/day for males Nutrition and the Elderly - Needs decrease - Fixed incomes - Chewing or Swallowing issues- dentures, missing teeth, dysphagia, special diets. - Thirst sensation decreases - Physical Limitations - Effects of medications & drug-food interactions Modified Diets ATI Chapter 8 Regular Clear liquid Full liquid Blenderized liquid (puree) Soft (bland, low-fiber) Mechanical soft Dysphagia Set your patients up to eat!! Enteral Nutrition ATI Chapter 9 Enteral nutrition (EN) provides nutrients into the GI tract. It is physiological, safe, and economical nutritional support. Nasogastric, jejunal, or gastric tubes Surgical or endoscopic placement Nasointestinal Gastrostomy Jejunostomy PEG (percutaneous endoscopic gastrostomy) PEJ (percutaneous endoscopic jejunostomy) Enteral Tube Feeding Nasogastric Nasointestional Gastrostomy Jejunostomy Enteral Feeding: • Start low increase as tolerated • Follow institution policy • Change feeding bags every 24 hours unless policy states different • Monitor patient tolerance to tube feedings. • Monitor Glucose every 6 hours. Enteral Feeding Management Nutritional management Insert feeding tube as ordered. Initiate enteral feeding as prescribed. Advance tube feeding as tolerated; monitor for tolerance. Aspiration precautions Position head of bed elevated a minimum of 30 degrees. Check tube placement every 4 to 6 hours. Check gastric residual volume every 4 hours. Aspiration Precautions ID patients at risk for aspiration Observe patients during mealtime—with different consistency of food Notify provider & other team members Elevate HOB 90 degrees Thickened foods or liquids Cuing during meals Observe for coughing, choking, etc—palpate for swallowing on throat Have pt sit up for at least 30 minutes after meal 100% of meal must be observed/assistance PRN Total Parental Nutrition ATI Chapter 10 Parental Nutrition Administered to clients who are unable to digest or absorb enteral nutrition The goal is to move patients from Parental Nutrition to Enteral Nutrition to ORAL intake. Peripheral or through a central line Initiating parenteral nutrition Preventing complications Barriers ATI Chapter 11 Poor Dental care Lack of resources Cavities Missing teeth Access to good foods Cognitive Disorders Dementia and Alzheimer's Altered sensory perception Impairment of swallowing Mechanical fixation to jaw Lack of knowledge Medical conditions Final Thoughts Nutrition is in all that we do as nurses. Being aware of acute nutritional needs of your patient Encourage healthy eating Understand what assistance your patient will require based on nutritional needs and ability to get those nutrients.
