NUTRITION
Nursing Implications
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Nutrition
• All of the processes involved in consuming
and utilizing food for energy, maintenance,
and growth.
Physiology of Nutrition
Five processes are involved in the body’s use of
nutrients:
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Ingestion.
Digestion.
Absorption.
Metabolism.
Excretion.
Ingestion
• The taking of food into the digestive tract,
generally through the mouth.
Digestion
• The mechanical and chemical processes that
convert nutrients into a physically absorbable
state. Digestion includes:
– Mastication (chewing).
– Deglutition (swallowing).
– Peristalsis (coordinated, rhythmic, serial contractions of
the smooth muscles of the GI tract).
Absorption
• The process by which the end products of
digestion pass through the small and large
intestines into the blood or lymph systems.
Metabolism
– The body’s conversion of nutrients into
energy.
– Basal metabolism is the amount of energy
needed to maintain essential physiologic
functions when a person is at complete
rest, both physically and mentally.
Excretion
– The process of eliminating or removing
waste products from the body.
The Six Essential Nutrients
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Water
Carbohydrates
Fats
Proteins
Vitamins
Minerals
Water
• The Most Important Nutrient.
• Daily requirements: 1,000mL of water to
process 1,000kcal eaten.
Functions of Water
• Solvent (dissolves
substances to form
solutions).
• Transporter (carries
nutrients, wastes, etc.
throughout the body).
• Regulator of body
temperature.
• Lubricant (aids in providing
smooth movement for
joints).
• Component of all cells.
• Hydrolysis (breaks apart
substances, especially in
metabolism).
Classification & Sources
of Water
• Liquids consumed (water, coffee, juice, tea,
milk, soft drinks).
• Foods consumed (especially fruits and
vegetables).
• Metabolism (produces water when
oxidization occurs).
Water: Digestion, Absorption and
Storage
• Water is not digested. It is absorbed and used by
the body as we drink it. It cannot be stored by the
body. The body loses water in four ways:
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Urine.
Feces.
Perspiration.
Respiration.
Water: Signs of Deficiency
• Abnormal water losses include profuse
sweating, vomiting, diarrhea, hemorrhage,
wound drainage (burns), fever, and edema.
• A deficiency of water is called dehydration.
Prolonged dehydration results in death.
Carbohydrates
• The chief source of energy for the body.
Made up of carbon, hydrogen, and oxygen.
They are the major source of food for all
people.
• Daily requirements: 50% to 60 of an
individual’s kcal intake per day.
Functions of Carbohydrates
Carbohydrates are...
• The primary source of energy for the body.
• Spares proteins from being used for energy, thus allowing
them to perform their primary function of building and
repairing body tissues.
• Needed to oxidize fats completely and for synthesis of fatty
acids and amino acids.
Carbohydrates: Classification and
Sources
• Carbohydrates may be simple or complex.
• Simple are single or double sugars.
• Complex are composed of many single sugars
joined together (starch, dietary fiber,
glycogen).
Carbohydrates: Digestion, Absorption
and Storage
• Digestion of cooked starches begins in the
mouth.
• Little digestion occurs in the stomach.
• Carbohydrate digestion completed in the
small intestine.
• Carbohydrates are used completely, leaving
no waste for the kidneys to excrete.
Carbohydrates: Signs of Deficiency
• Mild deficiency can result in weight loss and
fatigue.
• Serious deficiency can result in ketosis.
Fats
• The most concentrated source of energy in
the diet. An essential nutrient, but too much
can be a health hazard.
• Daily requirements: should not exceed 25%
to 30% of an individual’s caloric intake per
day.
Functions of Fats
• Provides concentrated source of energy.
• Assists in absorption of fat-soluble vitamins.
• Is a major component of cell membranes and myellin
sheaths.
• Improves flavor of foods and delay’s stomach’s emptying
time.
• Protects and hold organs in place.
• Insulates body, thus assisting in temperature maintenance.
Classification of Fats
• Triglycerides (true fats).
• Phospholipids (lipoids, composed of glycerol,
fatty acids, and phosphorus).
• Cholesterol.
Sources of Fats
• Animal (lard, butter, milk, cream, egg yolks,
and fat in meat, poultry, and fish).
• Plant (oils from corn, safflower, peanut, palm,
etc., as well as nuts and avocado).
Digestion, Absorption and Storage of
Fats
• No chemical breakdown of fats occurs in the
mouth and very little in the stomach.
• Digestion occurs in small intestine.
• Fats not immediately needed by the body are
stored as adipose tissue.
Fats: Signs of Deficiency and Excess
• Deficiency occurs when fats provide less than
10% of daily kcal requirement.
• Gross deficiency may result in eczema,
retarded growth, and weight loss.
• Excess fat consumption can lead to
overweight and heart disease.
Proteins
• The only nutrient that can build, repair, and
maintain body tissues.
• Daily requirements: determined by size, age,
gender, and physical and emotional conditions.
• Daily protein requirement for average adults
is 0.8g for each kilogram of weight.
Functions of Proteins
• To provide amino acids necessary for synthesis of body
proteins, used to build, repair, and maintain body tissues.
• To assist in regulating fluid balance.
• Used to build antibodies.
• Plasma proteins help control water balance between the
circulatory system and surrounding tissues.
• In event of insufficient stores of carbohydrates and fats,
protein can be converted into glucose and used for energy.
Classification & Sources of Proteins
• Complete proteins contain all 9 essential
amino acids. (All animal fats, except for
gelatin, are complete. Only plant fat that is
complete is soybeans).
• Incomplete proteins have one or more
essential amino acids missing (plant
proteins).
Digestion, Absorption and Storage of
Protein
• Digestion begins in the stomach.
• Most digestion takes place in the small
intestine.
• Amino acids not used to build proteins are
converted to glucose, glycogen, or fat and are
stored.
Signs of Deficiency and Excess of
Protein
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Muscle wasting.
Edema (swelling).
Lethargy and depression.
Excess can result in heart disease, colon
cancer, osteoporosis.
Vitamins
• Essential organic compounds that regulate
body processes and are required for
metabolism of fats, proteins, and
carbohydrates.
• Needed in very small amounts.
BODY WEIGHT/BODY MASS
• Ideal body weight
• Body mass index
• Percent body fat
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FACTORS AFFECTING NUTRITION
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Development
Gender
Ethnicity & culture
Beliefs about food
Personal preferences
Religious practices
Lifestyle
Medications & therapy – table 45-1
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FACTORS AFFECTING NUTRITION
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Health
Alcohol abuse
Advertising
Psychologic factors
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NUTRITION THRU THE
LIFE CYCLE – Young & Middle Adult
• Lay foundation for lifetime nutrition pattern in young
adulthood
• Nutrient requirements change very little
• Females need to maintain/increase intake of Vit. C ,
Vit D, & calcium; & maintain intake of iron
• Basal metabolism decreases 2-3%/decade after age
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• Obesity, HTN , & DM may begin to form
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NUTRITION THRU THE
LIFE CYCLE – Older Adults
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Physiologic, psychosocial, economic changes
Need fewer calories
Nutrient requirements basically the same
Variety & nutrient dense foods; water
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Factors Affecting Nutrition:
Ethnicity & Culture
• Native American
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Starches: corn, rice
Fruits: berries
Veggies: rhubarb, mushrooms, roots
Meats: game, seafood, nuts
Milk: little used
• High incidence of lactose intolerance
• Encourage broiled, poached, steamed meats
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Factors Affecting Nutrition:
Ethnicity & Culture
• U.S. Southern
– Starches: cornbread, biscuits, potatoes
– Fruits: melons, peaches, bananas
– Veggies: collards, okra, tomatoes, cabbage
– Meat: pork, chicken, fish
– Milk: milk, ice cream
• Many foods fried, cooked with lard
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Factors Affecting Nutrition:
Ethnicity & Culture
• Mexican
– Starches: tortillas, corn products
– Fruits: few
– Veggies: chili peppers, tomatoes, onions
– Meat: beef, poultry, eggs, pinto beans
– Milk: cheese; rarely drink milk
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Factors Affecting Nutrition:
Beliefs & Preferences
• Individual likes & dislikes
• Beliefs about foods
• Fad diets
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Factors Affecting Nutrition:
Religious Practices
• Christianity
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Catholics
Eastern Orthodox
Mormons
Seventh Day Adventists
• Islam
– No pork or alcohol; daylight fasting during Ramadan
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Factors Affecting Nutrition:
Lifestyle
• Economic & social status
• Work/activities
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Factors Affecting Nutrition:
Medications, Therapy, & Health
• Therapies
– Chemo, radiation
• Health
– GI disorders, viruses, oral ulcers
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Factors Affecting Nutrition:
Alcohol, Advertising, & Psych
• Alcohol
– Can depress appetite
– Abuse can lead to malnutrition (esp Vit B)
• Advertising
– May influence food choices
• Psych
– Overeat vs. don’t eat when stressed, depressed
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DIETARY GUIDELINES
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Eat a variety of foods
Maintain or improve your weight
Be physically active every day
Eat diet low in trans fat, saturated fat, & cholesterol
Eat plenty of vegetables, fruits, & grains
Use sugars in moderation
Use salt & sodium in moderation
If you drink alcohol, do so in moderation
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Food Guide Pyramid
Fats, oils & sweets
Use sparingly
Milk, Yogurt & Cheese
Meat, poultry, fish, dry beans, eggs & nuts
2-3 servings
Vegetables & Fruits
(2-5 servings)
Bread, cereal, rice & pasta
(6-11 servings)
FOOD GUIDE PYRAMID
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Healthy Eating Pyramid
Daily exercise & weight control
Whole grains at most meals
Vegetables in abundance
Fruits 2-3 times/day
Nuts, legumes 1-3 times/day
Fish, poultry, eggs 0-2 times/day
Dairy or calcium supplement 1-2 times/day
White rice, white bread, potatoes, pasta, sweets, red
meat, butter sparingly
• MVI for most
• Alcohol in moderation
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ALTERED NUTRITION
• Malnutrition – lack of necessary or
appropriate food substances
– Overnutrition – caloric intake in excess of daily
energy requirements
• Overweight – BMI 26-30
• Obese – BMI > 30
• Morbid obesity – interferes with mobility or breathing
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ALTERED NUTRITION
• Malnutrition
– Undernutrition – intake of nutrients insufficient to
meet daily energy requirements as a result of
inadequate food intake or improper digestion &
absorption of food
• Dysphagia – difficulty swallowing
• Anorexia – loss of appetite
• Protein-calorie malnutrition
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The Nursing Process: Assessment
Two types of data:
• Subjective.
• Objective.
Subjective Data
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24-Hour Recall.
Food-Frequency Questionnaire.
Food Record.
Diet History.
Objective Data
• Body Mass Index.
• Skinfold Measurement.
• Other Measurements (e.g. Abdominal-Girth,
Mid-Upper-Arm).
• Laboratory Tests.
RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Diet history
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Chewing or swallowing difficulties
Inadequate food intake
Restricted or fad diets
No intake for 10 or more days
Inadequate food budget
Inadequate food preparation facilities
Physical disabilities
Living & eating alone
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RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Medical history
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Unintentional wt loss or gain of 10% within 6 months
F/E imbalance
Oral or GI surgery
Dental problems
GI problems
Chronic illness
Alcohol or substance abuse
Neurologic or cognitive impairment
Catabolic or hypermetabolic condition
Adolescent pregnancy or closely spaced pregnancy
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RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Medication history
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Aspirin
Antacid
Antidepressants
Antihypertensives
Anti-inflammatory agents
Antineoplastic agents
Digitalis
Laxatives
Diuretics
Potassium chloride
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PHYSICAL EXAM
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General appearance & vitality
Weight
Skin
Nails
Hair
Eyes
Lips, tongue, gums, teeth
Heart
Abdomen
Musculoskeletal
Neurologic
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ANTHROPOMETRIC MEASUREMENTS
• Height & weight
• Skinfold measurements – tricep most common
site
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LABORATORY DATA
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Albumin & pre-albumin
Transferrin
Hgb
BUN
24 hour urine
Total lymphocyte count
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DIAGNOSING
• Altered nutrition: more than body requirements
• Altered nutrition: less than body requirements
• Altered nutrition: risk for more than body
requirements
• Fluid volume excess, fluid volume deficit, & risk for
fluid volume deficit
• Activity intolerance
• Constipation
• Risk for Impaired Skin Integrity
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PLANNING
• Client will:
– Maintain I&O balance
– Consume proper amounts of foods from variety of
food groups
– Comply with diet therapy
– Tolerate tube feedings
– Not have any complications assoc with
malnutrition
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IMPLEMENTING - Teaching
• Use established nutritional standards
• Use visualization of serving sizes to help ID
accurate serving sizes
• Incorporate culturally based intake patterns or
restrictions
• Include client & family
• Collaborate with dietician
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IMPLEMENTING
Special Diets
• NPO – nothing by mouth
• Clear liquid diet – water, tea, coffee, clear broths,
gingerale, plain gelatin
• Full liquid diet – clears; milk; cooked cereals,
pudding, ice cream, cream soup;
• Soft diet – easily chewed & digested
• Dysphagia – thickened liquids
• Diet as tolerated
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IMPLEMENTING
Stimulating Appetite
• Relieve illness symptoms that depress appetite prior
to mealtime
• Provide familiar food that person likes served at
proper temp.
• Select small portions
• Avoid unpleasant or uncomfortable treatments or
activity immediately before/after meals
• Provide tidy, clean environment
• Encourage or provide oral hygiene before mealtime
• Reduce psychologic stress
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IMPLEMENTING
Assisting with Meals
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Help client feed self when possible
Assist client to sit on side of bed or chair if possible
Check tray for client’s name, type of diet, & completeness
“which order would you like to eat?”
Spread napkin, cut foods, shell egg, etc.
Do not rush client; allow ample time
Offer fluids every 3 or 4 mouthfuls of food if client unable to
communicate
• Use adaptive feeding aids as needed
• For blind person, identify placement of food as you would
describe time on a clock
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IMPLEMENTING
Special Supplements
• Oral
– Provide calories & nutrients
– Can be liquid or powdered
– Specific types
• Tube Feeds
– When condition prevents food intake
– Impairment in upper GI tract, otherwise fx GI tract
– Increased metabolic needs that oral intake can’t meet
• Parenteral Nutrition
– IV nutrients (TPN, PPN)
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EVALUATING
Enteral Feeds
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Daily wt
I&O
Labs
Monitor for complications
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IMPLEMENTING
Home Care Teaching
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Preparation of formula
Proper storage of formula
Administration of feeding
Mgmt of enteral or parenteral access device
Daily monitoring needs
S/S of complications to report
Who to contact with questions/problems
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EVALUATING
• If outcomes not achieved,
– Was cause of problem correctly identified?
– Was family included in teaching plan? Are they
supportive?
– Is client experiencing symptoms that cause loss of
appetite?
– Were outcomes unrealistic for this person?
– Were client’s food preferences considered?
– Is anything interfering with digestion or absorption of
nutrients?
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TERIMAKASIH