 Normal
growth
 Tissue maintenance
 Tissue repair/recovery
 Treatment of disease
 Maintain
immune system
 Prevent medical problems
 Maintain normal temp
 Produce enzymes and
hormones
 Intake
of food/fluids
 Mechanical Digestion
 Chemical digestion of
starches begins
 Passageway
from the mouth
to the stomach
 Peristalsis
forward
propels food
 Turns
food into chyme
 Adds HCL
 Mechanical and chemical
digestion continues
 Food stays for 1-4 hours


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Simple carbohydrates
1hr
Complex carbohydrates 3hr
Protein
5hr
Fats
7hr
Rationale for a variety of foods in % of intake
 Chemical
digestion
 Bile and enzymes are added
 Digestion completed
 Absorption of nutrients
occurs
 Storage
of wastes
 Absorption of water
 Elimination
 Synthesis of Vitamin K
 Psychological
State-fear,
anxiety
 Bacterial action
 Food processing-whole grain,
raw, fried, cooked
 Substance
which contains
elements necessary for body
function
 6 classes: CHO, CHON, Fat,
H2O, Minerals, Vitamins
 Provide
energy
 Primary
plant foods
 May contain
fiber
 Simplest
form is
glucose
 Anabolism
 Catabolism
 Converted to
adipose
 Amino
acids
 Tissue growth/repair
 Complete proteins
 Incomplete proteins
 Nitrogen balance
 Fats
and oils
 Concentrated
energy
 Triglycerides
 Provide
insulation
 Maintain
temperature
 Fat-soluble
vitamins
 Most
essential nutrient for
survival
 Essential for cells
 Sources--eating, drinking,
metabolism





Sodium: Less than 3000mg
Cholesterol: Less than 300mg
Fat: Less than 30 %
Fiber: Approximately 30 Grams
Fluids: 3000ml / 24 hour
 Fat
soluble--A, D, E, K
 Water soluble-B-complex, C
 Regulate metabolic functions
within cells
 Contain antioxidants
 Inorganic
elements
 Serve as catalysts
 Essential for good health
 Calcium, phosphorus,
magnesium




Infants: double wgt 4-5 mo. Not able to
digest or metabolize many foods
Toddlers & pre-schoolers: need increase in
protein r/t body wgt.
School age + adolescents: generally have
good appetites. Need healthy selection ed.
Adults: Fruits, veg, whole grain & portion
control



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
May have fixed income
May not be able to go out and shop
Decrease in taste buds
Loss of teeth , poor fitting dentures
Don’t enjoy eating alone
 Health
 Socio
- Economic status
 Psychological state
 Culture/religion
 Personal
preferences
 Misinformation-food fads
 Alcohol and drug use
 Age and life-style
 Alcohol = 7calories/gram

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Hgt & wgt
I&O trends
Body composition
Edema
Condition of skin, teeth, hair
Dietary history
Turgor
Dietary diary
Anthropometry
Calorie count
Stool characteristics

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Albumin-role in F&E balance
Pre-albumin-more reliable
Transferrin-non-hem iron->when iron< and
< when iron >
Hbg-O2 carrying capacity < blood loss
BUN = hydration and Creatinine
2000 calorie diet 60% carbohydrate
20% protein
20% fat
calories
2000X60%=1200/4cal per g=300gram
CHO
2000x20%= 400/4cal per
g=100gramCHON
2000x20%= 400/9cal per g=44grams
Fat




Represents allowances of essential nutrients
by age and category, inclusive of weight and
height.
Represents 98% of people in general good
health
55-60% carbohydate
12-20% protein
<30% fat

Anyone with problems with I & O, digestion
and absorption of nutrients
◦
◦
◦
◦
◦
Anorexia nervosa
Bulimia
Chemotherapy
Chronic illness
Extensive surgery
--Impaired mobility
--Lengthy NPO
Most reliable indicator is
WEIGHT
Intake and output are very
important and must be
accurate

 Provide
rest to a body part
 Adapt to client’s ability to eat
swallow, digest, absorb, or
metabolize nutrients
 Weight loss or gain
 Maintain nutritional status
 Correct deficiencies
 Consistency/texture
 Frequency
of feedings
 Number of calories
 Specific nutrients
 Fluid volume
 Tea,
broth, jello, water
 Liquids you can see through
 Nutritionally inadequate
 Foods
that are liquid at body
temperature
 May be nutritionally adequate
if planned carefully
 Foods
which are easy to chew
and to digest
 Mechanical soft/pureed
 Non-irritating
 Chemically
 Thermally
 Mechanically
foods
 Residue
has to do with
fiber
 Hi=increase peristalsis
 Low-decrease peristalsis
 Regulates the volume of
fecal output
 Sodium
restricted: reduces fluid
retention and allows heart to
work less
 Low fat or cholesterol: reduces
the plaque formation in blood
vessels, limiting CAD

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

Offer bathroom
Wash face/hands
Oral care
Glasses/hearing aids
Position of comfort prior to food served
Reinforce importance of intake







Serve food in pleasant social setting
Prepare tray
Place in reach and in visual field
Encourage social interaction
Assist with feeding if necessary
Know precautions
Protect clothing with apron-not bib





Allow client to empty mouth before putting
more food in
Encourage client to direct speed/order
Be at eye level/face to face
Allow for rest periods
Avoid heaping food on utensils
 Record
accurate intake and
output
 Note % ¼ , ½ ,¾ ,or 100%
 Provide oral hygiene
 Offer fluids or supplements as
ordered thru shift
Feedings administered through a
tube directly into the stomach or
small intestine
 Naso-gastric tube
 Gastrostomy tube
 Jejunostomy tube

 Comatose
clients
 Severe reflux disease
 Paralysis of muscles used for
swallowing
 Obstruction
 Weakness
 X-ray
verification
 Aspirating gastric contents
 Instilling air through tube while
auscultating with a stethoscope
 Ask client to speak
Check placement q 4 h and prn
 Check residual q 4 h and prn
 Keep HOB up 30 degrees
 Abdominal assessment, temp, lung
sounds q shift and prn, stooling
 Report N/V

Change bag q 24 hrs
 Measure and record I&O q 8 h
 Flush tube with water -- institutional
policy re: meds and feedings
 Give meds individually!! Flush
between each med
 Observe rate of flow

 Provide
hydration
 Administer meds
 Access circulatory system
 Provide electrolytes
 Give blood
 Observe
rate and flow and
correct solution
 Record I&O
 Check insertion site
 Assess client’s fluid balance
 Inflammation
of a vein
 Red streak
 Warmth
 Pain
 Edema
 Fluid
infuses
readily
 Good blood
return
 Skin
pale in
area
 Skin cool
 Edema
 Firm to
touch
 Feels
“tight”
or “burns”
 Infuses
sluggishly
 No blood
return
 Contains
all necessary
nutrients
 AKA Hyperalimentation
 Given via central line
Assess IV site q shift, dressing
 Weigh daily
 Record I&O
 Note infusion rate/ correct solution
 Assess fluid balance
 VS q 4 hr.
Accu checks




Electrolytes: ions and carry electric charge
when dissolved in fluid. + =cations=NA, K,
Ca, Mg.
---anions=Cl, HCO3
Minerals: ingested compounds, help regulate
body functions
Cells: functional basic units of all living
tissue. Cells within fluid=R and W blood cells


Intracellular: contained within each cell =40%
of body wgt
Extracellular: located outside the walls of the
individual cells and is divided into:
◦ Interstitual fluid: tissue fluid (edema)
◦ Intravascular fluid: within blood vessels
◦ Transcellular: CSF, digestive juices, synovial


Diffusion: Solutes move from an area of
higher concentration to an area of lower
concentration
Osmosis: movement of (solvent) water from a
solution of lower concentration to an area of
greater concentration


Active transport: Solutes are moved across a
semipermeable membrane with a source of
energy. Requires metabolic activity and
energy expenditure.
Filtration: process by which H20 & diffusible
substances move together in response to fluid
pressure

Decrease in the extracelluar fluid
(dehydration), n/v, diarrhea, hemorrhage
◦ S/S: Dry mucous membranes, decrease in BP,
increase in heart rate, elevated temp, decrease in
skin turgor, sunken eyes, diminished urine output,
rapid wgt loss, slow vein filling, confusion
◦ Tx: IV, antiemetics, stop diarrhea, tx cause

Increase in extracellular fluid (hypervolemia
or anasarca)
◦ Renal or liver failure, secondary to ds of the CV
system (CHF), protein deficiency, hormonal or
steroid therapy, excessive Na
◦ S/S: Dependent edema, rapid wgt gain, HTN,
polyuria, JVD, rales, ascites, orthopnea, bounding
pulse

Nursing Tx: HOB elevated
◦
◦
◦
◦
Frequent Vital Signs
Daily wgt
Sodium restriction
Skin care
I&O
Lung sounds
TCDB q 2 h
Tx: 02, IV therapy, fluid restriction,
diuretics, low Na diet, antiembolic hose

K: intracellular fluid 3.5-5.0 mEq/L.
◦ Nerve stimulus conduction, muscle activity
◦ Abnormal levels may cause cardiac irregular


Na: regulates fluid balance 135-145
mEq/L.
Ca: generally combines with phosphorus
to form the mineral salts of the teeth
and bone.
9.0-11.0mEq/L. Need for normal muscle
activity

Mg: necessary for neuromuscular
excitability