Chapter 43
Nutrition
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Elements of Energy and Nutrition
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Basal metabolic rate (BMR)
Resting energy expenditure (REE)
Nutrient density
Nutrients: carbohydrates, proteins,
fats, water, vitamins, minerals
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Carbohydrates
• Produce 4 kcal/g
• Main source of energy
• Saccharides: simple and complex
carbohydrates, fiber
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Proteins
• Produce 4 kcal/g
• Essential for growth, maintenance,
and repair of body tissue
• Amino acids: essential and
nonessential
• Complete and complementary
proteins
• Nitrogen balance
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Fats (Lipids)
• Produce 9 kcal/g
• Triglycerides and fatty acids
• Saturated or unsaturated:
monounsaturated or polyunsaturated
fatty acids
• Essential or nonessential fatty acids
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Water
• Comprises 60% to 70% of body
weight
• Cell function depends on a fluid
environment
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Vitamins
• Essential to normal metabolism
• Fat-soluble: A, D, E, K
• Water-soluble: C and B complex
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Minerals
• Inorganic elements essential as
catalysts in biochemical reactions
• Macrominerals
• Microminerals or trace elements
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Digestive System
• Anatomy and physiology
– Digestion
– Absorption
– Metabolism and storage of nutrients
– Elimination
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Dietary Guidelines
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Dietary referenced intakes (DRIs)
Food guidelines: food guide pyramid
Daily values
Healthy People 2010
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Nutritional Needs throughout
Growth and Development
• Infants through school-age
– Breast-feeding
– Formulas
– Solid foods
– Food habits
• Adolescents
– Eating disorders
– Activities
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Nutritional Needs throughout
Growth and Development (cont'd)
• Young and middle adults
– Pregnancy
– Lactation
• Older adults
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Alternative Food Patterns
• Cultural and religious practices
• Vegetarian diets
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Assessment: Diet History
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Dietary intake and pattern
Symptoms
Allergies
Taste
Chewing and swallowing
Appetite
Elimination
Medications
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Assessment
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Anthropometry
Body mass index (BMI)
Ideal body weight (IBW)
Laboratory tests
Clinical observations
Client expectations
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Nursing Diagnoses
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Risk for aspiration
Constipation
Diarrhea
Imbalanced nutrition: less than/more
than body requirements
• Feeding self-care deficit
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Planning
• Goals and outcomes
– Client’s daily nutritional intake meets the
minimum DRIs
– Client loses ½ pound per week
• Setting priorities
• Continuity of care
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Implementation:
Health Promotion
• Client education
• Meal planning
• Food storage and preparation safety
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Implementation: Acute Care
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Advancing diets
Promoting appetite
Assisting clients with feeding
Enteral feeding
Parenteral nutrition
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Enteral Feeding
• Nasogastric, jejunal, gastric tubes
• Insertion and verification of
placement
• Types and preparation of formulas
• Complications
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Parenteral Nutrition
• Initiation and management of
insertion site
• Types of solutions
• Rate of infusion
• Prevention of complications
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Implementation: Restorative Care
• Medical nutrition therapy for specific
illnesses, conditions, or injuries
– GI diseases
– Diabetes
– Cardiovascular diseases
– Cancer
– HIV
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Evaluation
• Client care
• Client expectations
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