Stressors that affect
Nutrition
NUR101
FALL 2008
LECTURE # 24
K. BURGER, MSED, MSN, RN, CNE
PPP By
Sharon Niggemeier RN MSN
Revised 12/08 J Borrero
Nutrition
• Nutrition is interaction between an
organism and the food it consumes
• Food & eating is a basic need, affects
health
• Various factors affect nutrition
• Nutrients – substances used by the
body for growth & development
• Role of nurse to teach, guide and
inform on the importance of
proper nutrition
Nursing Assessment
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Dietary intake and food preparation
Unpleasant symptoms
Allergies
Taste, chewing and swallowing
Appetite and weight
Use of medications
Nutritional health-care Team
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MD
Nurse
Social Worker
Physical Therapist
Occupational Therapist
Speech Pathologist
Pharmacist
Essential Nutrients
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Water
Carbohydrates
Proteins
Lipids
Regulatory Nutrients
• Vitamins
• Minerals
Water
• Water: present in every cell
• Absorbed in small /large intestine
• Metabolized carbohydrates, proteins,
lipids produce water
• Dietary intake from fluids and solid
food provide water
• Function: fluid medium needed for all
chemical reactions in the body
Carbohydrates
• Carbohydrates: simple or complex
• Digested by enzymes
(amylase/lactase)
• Absorbed in small intestine
• Metabolized into glucose which is
used for energy or stored…Stored as
either glycogen or fat
• Function: provide energy, spare
proteins
Carbohydrates (CHO)
• Carbon – Hydrogen-Oxygen
• 1 gram carbohydrate = 4 Kcal
• Monosaccharides – simple sugars
glucose, fructose, galactose
• Dissaccharides – double sugars
sucrose, lactose, maltose
• Polysaccharides – complex forms
starch, glycogen, cellulose (fiber)
• Recommended intake: 60% of total Kcal (300g)
Fiber 25-30g daily
Carbohydrates
• What are some other functions of
carbohydrates in our bodies?
Laxative effects of:
DIETARY FIBER Helps regulate blood
sugar
Lactose
Cellulose
May reduce risk of
hyperlipidemia
May reduce risk of some
cancers
Protein
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Proteins: composed of amino acids
Digested by enzymes (proteolytic)
Absorbed in small intestine
Metabolism includes:
Anabolism=Catabolism: Nitrogen
balance
• Function: maintain body
tissue and tissue growth
Protein (CHON)
• Carbon-Hydrogen-Oxygen- Nitrogen
• 1 gram of protein = 4 Kcal
• Comprised of 22 amino acids which can be comined by
body to form over 1000 types of proteins
• 9 essential amino acids – body cannot synthesize them
• Complete protein = one with all 9 essential amino acids
(animal sources and soy)
• Incomplete proteins = contain some but not all essential
(plant sources)
• Complementary proteins = 2 proteins that when
combined provide all essential amino acids.
• Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)
Proteins (CHON)
• What are some other functions of proteins?
Fluid Balance
Ex: Albumin
Energy ( last resort)
De-amination / Nitrogen
stripped from CHON to
create glucose CHO
Lipids
• Lipids: insoluble in water
• Digested by enzymes (lipase,bile) in
stomach and small intestine
• Absorbed in small intestine
• Metabolism includes conversion (by
liver and small intestine) into soluble
compounds called lipoproteins
• Function: energy, insulates body,
absorption (fat-soluble vitamins)
Lipids (Fats)
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Carbon-Hydrogen-Oxygen
1 gram of Fat = 9 Kcal
Composed of fatty acids: (linoleic&linolenic =essential)
Saturated fat = mostly animal source
Unsaturated fat = mostly plant and fish sources
Triglyceride = fat in bloodstream /storage form of fat
in body.
• Trans Fat = hydrogenated fats in processed foods
• Recommended intake: 20-35% of total Kcal
Lipids
• Lipoproteins - made by the body to move waterinsoluble lipids (such as cholesterol) thru the
bloodstream
• LDL (low density lipoprotein)- major carrier of
cholesterol. Function is to transport cholesterol
from liver into circulation. “Bad cholesterol”
• HDL (High density lipoprotein) - carries
cholesterol away from tissue to liver ..high levels
decrease atherosclerosis. “Good cholesterol”
• Cholesterol- not essential from diet as the body
produces enough.
Desirable Blood Lipid Levels
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Total Cholesterol
Triglycerides
LDL
HDL
< 200
< 150
< 100
> 40 Male
> 50 Female
• Elevated Blood Lipid Levels
(Hyperlipidemia) = increased risk for CHD,
Hypertension, Stroke, MI
Vitamins
• Vitamins: required in small amounts
• water- soluble: absorbed through
intestine directly into blood stream (C,
B complex folic acid)
• fat-soluble: absorbed with lipids into
lymphatic circulation (A,D,E,K)
• Function: needed for metabolism of
carbohydrates, lipids & proteins
Water-soluble vitamins text review
Vitamin C (ascorbic acid)
• Function: collagen formation (wound
healing), antioxidant, immune system
• More prone to deficiency; not stored
• Deficiency: bleeding gums, scurvy,
poor wound healing
• Source: citrus fruits,
tomatoes, broccoli
Vitamin B Complex : thiamine,
riboflavin, niacin, B6, B12
• Function: metabolism of carbs, lipids
and proteins
• RNA, DNA synthesis (folic acid) &
heme formation (B12)
• Deficiency:beriberi, poor wound
healing, anemia, pernicious anemia
• Sources: Whole grains
Organ meats
Vitamin B12 (continued)
Vitamin B12 (cobalamine)
• Important for hemoglobin synthesis
• Very little found in vegetable sources (unlike other B Vitamins)
• Pernicious anemia = B12 deficiency or lack of intrinsic
factor for B12 absorption.
Susceptible population = Total Vegan
Clients w/ decreased gastric acid secretion
(gastric bypass, stomach cancer)
• Rx = B12 injections
Folic Acid
Folic Acid (Folate)
• Folic Acid Deficiency leads to elevated Homocysteine
levels which are associated with increased risk for CHD.
• Folic Acid Deficiency linked to neural tube defects –
Spina Bifida
• Natural folate (in foods) only ½ as available to body as
supplement folic acid
• 1998 = mandatory fortification of breads/grains
• Supplements recommended for: women of child-bearing
age, gastric surgery, malabsorption (alcholic)
Fat-soluble Vitamins text review
• Vitamin A: function- visual acuity, skin
maintenance…deficiency-night blindness
Dark green leafy vegs, yellow/orange vegs
• Vitamin D: function-calcium absorption… deficiencyrickets, bone malformation
Fortified milk, ultraviolet light
• Vitamin E: function-antioxidant, heme
synthesis…deficiency-RBC hemolysis
Whole grains, nuts
• Vitamin K: function-formation blood clotting
proteins…deficiency- hemorrhage
Dark green leafy vegs, synthesized by bacteria in sm
intestine
• More prone to toxicity; stored by body
Minerals
• Minerals: macrominerals or microminerals
• Originate in earth’s crust, aren’t digested or
metabolized. Combine to form salts or organic
compounds. Always retain their chemical
properties.
• Function: provide structure within the body
(bones/teeth, F/E and acid /base balance, nerve
transmission, muscle contraction)
Macrominerals text review
• Calcium: bone/ teeth formation, blood clotting,
nerve transmission…deficiency-tetany,
osteoporosis
• Phosphorous: bones, acid-base
balance…deficiency- muscle weakness
• Magnesium: bones, metabolism ...deficiencymuscle pain, poor cardiac function
• Potassium: f/e balance, acid-base balance…
deficiency-muscle cramps , irregular ht. rate
Microminerals
text review
• Iron: hemoglobin
formation…deficiency-anemia
• Iodine: thyroid hormones…deficiencygoiter
• Zinc: wound healing … deficiencyimpaired immune system
• Fluoride: teeth/bones…deficiencydiscolored tooth enamel
Energy Balance
• Kilocalorie- unit of heat; measures the
energy in the diet
• Basal metabolic rate (BMR)- amount
of energy needed for all the
biochemical processes to occur when
the body is at rest.
• Proper nutrition provides the energy
needed to maintain health
Body Weight Standards
• Ideal body
weight IBW =
balance of
energy used
by the body
and intake of
nutrients
• Rule of thumb
Women: 100 lbs lst 5ft
5 lbs/inch over 5ft
Men: 106 lbs lst 5 ft
6 lbs/inch over 5ft
• Standardized charts
Overweight = 10% > chart
Obese = 20% > chart
• Body mass index(BMI)
18.5 – 24.9 healthy
> 25 = overweight
> 30 = obese
> 40 = morbidly obese
Calculate your BMI
Weight (lbs)
X 705
Height (inches) squared
Factors Affecting Nutrition
• Developmental
• Gender
• Ethnicity &
culture
• Food beliefs
• Preference
• Religion
Factors Affecting Nutrition
• Lifestyle
• Medications &
therapy
• Heath status
• Advertising
• Alcohol
Consumption
• Psychological
factors
Adequate Nutrition
• Food Guide
Pyramid
• Daily reference
intake
• Food Labeling
• Dietary guidelines
Dietary Guidelines
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Balance / Moderation / Variety
Maintain healthy weight
Exercise
Eat a variety of foods in moderation
Low sodium / Low fat / Low simple sugars
Alcohol in moderation
Assessing: Nutrition
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Nursing history
Physical exam
24-hr. recall
Food records
Anthropometic data
Lab tests – Albumin & Prealbumin
Hemoglobin
Transferrin
Nursing Dx
• Imbalanced nutrition: less than body
requirements R/T NPO status AEB
height 5’6’’ wt 105 lbs., pt. states
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I’ve never been this skinny before, my
clothes are hanging off of me”
• Impaired dentition R/T nutritional
deficits AEB dentures not fitting
properly
Planning- outcome criteria
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Pt. will:
Attain and maintain ideal body weight
Eat a variety of foods at each meal
Promote healthy nutritional practices
Interventions
• Monitoring food
intake
• Assist with
feeding
• Stimulate
appetite
• Teaching
Diet Restrictions
• Low residue- no seeds,
• NPO
raw vegetables or
• Clear liquids-see
fruits, whole grains
through (broth,
• High fiber- raw fruits,
apple juice)
grains, vegetables
• Full liquids –foods • Sodium restricted:
that turn to liquid at
– Mild 2 gram Na/day
room temp.
– Moderate 1gram
– Strict 500mg
(shakes, milk)
– Severe 250 mg
• Soft –easily chewed
– DASH Dietary Approaches
and digested
to Stop Hypertension
Diet Restrictions
• Calorie
restrictions
• Diabetic diet
• Cholesterol
• Food
textures:Thick it
• Thin
• Nectar-like
• Honey-like
• Spoon-thick
Enteral Nutrition
• Used when oral intake is inadequate,
swallowing difficulty, coma
• Tube passed into gastrointestinal tract
to deliver nutrients
• Maintains GI integrity preferred over
parental feedings (via veins)
Enteral Nutrition
• Short term use
• Nasogastric
• Nasointestinal
• Long term use
• Gastrostomy
• Percutaneous
endoscopic
gastrostromy
(PEG)
Enteral Formulas
• Many types of formulas
• Administered continuous or
intermittent
• Use pumps to monitor intake
• Monitor Intake & Output
Enteral Precautions
• Prevent aspiration
– Position fowlers/high fowlers
– Assess placement…check pH
– Note residual
– Auscultate bowel sounds
Enteral Precautions
• Preventing complications include:
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Clogged tube
Nasal erosion
Diarrhea
Infection
Dislodgement
Parental Nutrition
• Bypasses GI tract, nutrition
administered IV, more complicated
• Total parental nutrition (TPN) also
called (hyperalimentation)…central
line
• Partial parental nutrition (PPN)..PICC
line
Evaluation
• Use established outcomes to evaluate the
pt’s response to care
• Pt understanding of therapeutic diet
• Reassess S&S associated with altered
nutrition (wt, intake, lab results)
• Determine pt’s satisfaction with nutritional
therapy
Summary
• Nurses role, to understand nutrients and
how they affect nutrition
• Various factors affect one’s nutritional
status
• Interventions include numerous diets,
assisting with feeding, monitoring and
teaching
• Nutrition can also be administered
enterally or parentally