Basic Nutrition and
Nutritional Therapy
Foundations of
Nursing
Christensen
Kockrow
Mosby 5th edition
Sharon Kinley-Schwing BSN
Pacific College 2006
Prevention = nutrition one of the most important parts of
health care.
Nutrition is the total of all processes involved in the taking in
and utilization of food substances for proper growth,
functioning, and maintenance of health.
Nutrition plays a role directly or indirectly in all body
processes, and disease states.
Proper nutrition may help prevent or delay onset of many
diseases.
Nutrition is the most over looked part of healthy living.
Role of the Nurse in Promotion Nutrition
The nurse can promote good nutrition by:
– Helping the patient understand the importance of the diet and
encouraging dietary compliance.
– Serving meal trays to patients in a prompt and positive
manner.
– Assisting some patients with the eating process.
– Taking and recording patient weight.
– Recording patient intake.
– Observing clinical signs of poor nutrition and reporting them.
– Serving as a communication link.
– Nurse can apply nutrition to their personal lives, what a
better reason to understand nutrition for your own health.
NUTRITION
All of the processes involved in consuming
and utilizing food for energy,
maintenance, and growth.
These processes are ingestion, digestion,
absorption, metabolism, and excretion.
INGESTION
The taking of food into the digestive
tract, generally through the mouth.
In special circumstances, ingestion
occurs directly into the stomach,
through a feeding tube.
DIGESTION
Mechanical and chemical processes
converting nutrients to a physically
absorbable state:
– Mastication–chewing
– Deglutition–swallowing
– Peristalsis–rhythmic, coordinated, serial
contractions of smooth muscles of GI tract
ABSORPTION
The process whereby the end products of
digestion pass through the epithelial
membranes in small and large intestines
and into blood or lymph systems.
Villi–small finger-like projections that line
the small intestine. Most nutrients are
absorbed directly through the villi.
METABOLISM
The conversion of nutrients into energy.
Anabolism–the constructive process of
metabolism, requires energy.
Catabolism–the destructive process of
metabolism, releases energy.
Basal metabolism–the energy needed to
maintain essential physiologic functions.
EXCRETION
The process of eliminating or
removing waste products from
the body.
NUTRIENTS
The body must have six types
of nutrients to function
efficiently and effectively:
Water
Proteins
Carbohydrates
Vitamins
Fats
Minerals
Dietary Guidelines for Americans:
These guidelines form the foundation of U.S. federal
nutrition policy and directly affect federal nutrition
programs such as food stamps, school breakfast and
lunch programs, and the Special Supplemental
Program for Women, Infants, and Children (WIC).
These guidelines have been developed to address the
importance of adequate nutrition, as well as the
prevention of over nutrition and disease.
Dietary Reference Intakes:
This is a set of nutrient-based values that can be used for
both assessing and planning diets.
They form the basis for daily values used in the
Nutrition Facts labels on foods.
The DRIs are intended to help individuals optimize
their health, prevent disease, and avoid consuming
too much of a nutrient.
Essential Nutrients
– Basic Functions:
Essential nutrients are those that our bodies cannot make in
amounts necessary for good health.
The six classes of essential nutrients are carbohydrates,
fats, proteins, vitamins, minerals, and water.
Provide energy
– Carbohydrates and proteins: 4 kcal/g
– Fat: 9 kcal/g
Build and repair tissue
– Protein, calcium, phosphorus, iron, and fat
Regulate body processes
– Metabolism: the combination of all chemical processes
that take place in living organisms
CARBOHYDRATES
Made of the elements carbon, hydrogen,
and oxygen (CHO)
Constitute the chief source of energy for
all body functions.
Requirements are 50–60% of total kcal
intake per day.
Carbohydrates
Carbohydrates:
Simple Carbohydrates:
Complex Carbohydrates:
Digestion and Metabolism of Carbohydrates:
CARBOHYDRATE FUNCTIONS
Primary source of energy for the body.
About half-day supply stored in liver and
muscles for use as needed.
Spares proteins from being used for energy.
Needed to oxidize fats and for synthesis of
fatty acids and amino acids.
Carbohydrate Absorption & Storage
Digestion begins in mouth, little takes place
in the stomach, is completed in the small
intestine.
Leave no waste for kidneys to eliminate.
Absorption takes place in the villi.
Excess converted to glycogen and stored in
the liver or stored as fat.
DEFICIENCY AND EXCESS
Mild deficiency can cause weight loss
and fatigue.
Serious deficiency can cause ketosis.
Excess can cause obesity, tooth
decay, irritate the lining of the
stomach, or flatulence.
FATS
Most concentrated energy source in diet.
Provides 9 kcal per gram.
Also known as lipids.
Composed of carbon, hydrogen, and less oxygen
than carbohydrates.
Recommended: no more than 25–30% of daily
intake.
Fats (Lipids)
Lipids:
Saturated fatty acids:
Unsaturated fatty acids:
Trans Fatty Acids:
Cholesterol:
Digestion and Metabolism of fat:
Summary of Fatty Acid Classification
Saturated
Monounsaturated:
Polyunsaturated:
Trans:
Classification of LDL, Total HDL, Cholesterol
LDL Cholesterol:
Total Cholesterol:
HDL Cholesterol:
Functions of Fat
Provides concentrated source of energy.
Needed to absorb fat-soluble vitamins.
Major component of cell membranes and myelin
sheaths.
Improves flavor, delays emptying time.
Protects and helps hold organs in place.
Insulates the body.
CLASSIFICATION
Triglycerides (true fats) are composed of
one glycerol molecule attached to three
fatty-acid molecules.
Phospholipids (lipoids) are composed of
glycerol, fatty acids, and phosphorus.
Cholesterol (sterol) liver produces over
1000 mg every day.
Absorption and Storage
No breakdown occurs in the mouth, very little
digestion occurs in the stomach.
Digestion begins in the small intestine.
Final products of fat digestion are fatty acids
and glycerol.
95% absorbed in small intestine.
Excess fats stored as adipose tissue.
Deficiency and Excess
Deficiency occurs when fats provide less
than 10% of the total daily kcal
requirement.
May result in eczema, retarded growth,
weight loss.
Excess can lead to overweight and heart
disease.
Sources of Fat
Animal fats–lard, butter, milk, cream,
egg yolks, meat, poultry, and fish.
Plant fats–corn oil, safflower oil, olive
oil, cottonseed oil, peanut oil, palm oil,
and coconut oil, nuts, and avocado.
Protein
Amino Acids:
Complete proteins:
Incomplete proteins:
Vegetarian diets:
Digestion and Metabolism of Protein:
Protein-Kilocalorie malnutrition:
Proteins
Made of carbon, hydrogen, oxygen, and
nitrogen (CHON).
The only nutrient that can build, repair, and
maintain body tissues.
Daily requirement for average adults is 0.8g
of protein for each kilogram of body weight.
Functions Of Proteins
Provide amino acids, needed to build, repair,
and maintain body tissues.
Assist in regulating fluid balance.
Vital part of enzymes, hormones, blood
plasma.
Used to build antibodies.
Can be converted to glucose, for energy.
Protein Digestion and absorption
Begins in the stomach.
Most digestion takes place in small intestine.
End product is amino acids, absorbed into
the blood by the villi in the small intestine.
Excess amino acids are converted to glucose,
glycogen, or fat for storage.
Sign of Deficiency and Excess
Muscle wasting.
Edema.
Lethargy and depression.
Marasmus and Kwashiorkor.
Excess can contribute to heart disease, and
may be linked to colon cancer, osteoporosis,
and kidney damage.
Vitamins and Minerals
They are needed in small amounts; toxicity may occur
with over consumption.
They are best received from a balanced, varied diet.
Vitamins can be destroyed by heat, light, and exposure
to air.
Minerals cannot be destroyed because they are single
elements rather than compounds.
Both vitamins and minerals can be lost when foods are
cooked in water.
VITAMINS
Organic compounds essential to life and
health.
Regulate body processes, needed in very
small amounts.
No fuel value but required for metabolism
of fats, carbohydrates, proteins.
Functions are unique to each vitamin.
–Fat soluble:
A, D, E, and K.
Usually carried in the fatty
portion of food.
Can be stored by the body.
–Water soluble:
B vitamins and C.
Not stored in the body; excesses
excreted in the urine.
Digestion of Vits
Vitamins do not require digestion.
Fat-soluble vitamins are absorbed into the
lymphatic system, excesses are stored in
the liver and adipose tissue.
Water-soluble vitamins are absorbed
directly into the circulatory system, and
excesses are excreted in urine.
Deficiency/ Excess
Vitamin deficiencies can occur and
result in disease.
Vitamins consumed in excess
amounts can be toxic to the body.
Minerals
Inorganic elements that help regulate body
processes and /or serve as structural
components of the body.
Major minerals–more than 100 mg/day.
Trace minerals–less than 100 mg/day.
Functions are unique to each individual
mineral.
Classification and Sources
Classified as major minerals or trace
minerals.
Found in water and in unprocessed foods.
Some foods are enriched—some vitamins
are added to them.
Supplements may be needed during
growth periods, some clinical situations.
Digestion
The amount of a mineral absorbed by
the body is influenced by:
Type of food
Need of body
Health of absorbing tissue
Deficiency and Excess
Deficiency signs unique to each mineral.
Excesses can lead to toxicity.
Concentrated forms of minerals should
be used only on advice of a physician.
Excesses can cause hair loss, changes
in the blood, hormones, bones, muscles, and
nearly all tissues.
Vitamins
Antioxidant vitamins:
Vitamin A:
Vitamin C:
Vitamin D:
Vitamin E:
Vitamin K:
Folate Acid:
Thiamine:
Vitamin B 12:
Riboflavin:
Niacin:
Vitamin B6:
Biotin:
Choline:
Pantothenic Acid:
Vitamin C:
Mineral
Calcium
Phosphorus:
Magnesium:
Sulfur:
Sodium:
Potassium:
Chloride:
Iron:
Zinc:
Iodine:
Selenium:
Copper:
Fluoride:
Chromium:
Manganese:
WATER !
Nutrient most vital to life.
Makes up approximately 60% of adult body
weight and 80% of infant weight.
Provides form and structure to body tissues.
Acts as a solvent; necessary for most chemical
processes.
Transports nutrients and other substances.
Lubricates and protects moving parts of the
body.
Lubricates food and aids in digestion.
Regulates body temperature
SOURCES OF WATER FOR THE BODY
Liquids consumed, including water, coffee,
juice, tea, milk and soft drinks.
Foods consumed, especially vegetables and
fruits.
Metabolism, which produces water when
oxidization occurs.
WATER DIGESTION/ ABSORPTION,/STORAGE
Water is absorbed, not digested.
It is not stored and is excreted daily.
Sensible loss–aware of loss of water.
Insensible loss–not aware of loss of water.
Urine, feces, perspiration, and respiration
are the four ways the body loses water.
SIGNS OF
Dehydration:
– Deficiency of water, can cause death.
– Occurs from profuse sweating, vomiting,
diarrhea, hemorrhage, wound drainage,
fever, and edema.
Positive water balance when more water
taken in than used or excreted.
Selected Foods with Vit. C:
Selected Foods with Vit. D:
Factors that affect Calcium Absorption and
Excretion:
Factors that affect iron Absorption:
Basic Nutrition
Diet Planning Guides
A number of guidelines have been established in
the US to help guide Americans in healthy and
balanced eating.
– My Pyramid:
Bread, cereal, rice, and pasta group.
Vegetable group.
Fruit group.
Milk, yogurt, and cheese group.
Meat, poultry, fish, dried beans, eggs, and
nuts group.
Fats, oils, and sweets.
MyPyramid, a
personalized guide
to daily food
choices and
number of servings.
(From US Department of Agriculture, Washington, DC, 2005, US Government Printing Office.)
MyPyramid
U.S. Department of Agricultures, Pyramid symbolizes a personalized
approach to health eating and physical activity.
MyPyramid emphasizes key concepts in physical activity and eating.
Moderation is represented by the narrowing of each food group.
The wider base stands for food with little or no solid fats or added
sugars.
The Narrower top area is food with more added sugars and solid
fats.
Varity and proportionality is shown by different widths of food
groups.
This pyramid can be personalized at www.mypyramid.gov.
Life Cycle Nutrition
Life Cycle Changes
Nutritional needs change as a person
grows and develops.
Changes generally based on growth
needs, energy needs, nutrient
utilization.
Nutritional assessment should be
conducted to ascertain the nutritional
needs of the individual.
Pregnancy and Lactation
Nutrient needs during period of intensive
growth, such as pregnancy and infancy are
greater than any other time in life.
Evidence has proven that optimal nutrition
during pregnancy reduce risk of complications
during pregnancy and delivery.
Health diets and avoid alcohol and caffeine
play an important role prior to and after
pregnancy.
Concerns in Pregnancy
Weight gain:
Discomforts and complications:
Practices to avoid:
Lactation:
Infancy
The time from birth to 1 year of age is one
of the rapid growth and development.
The average infant birth weight triples by
the first birthday.
Nutrition is important for proper growth
and development.
Breast Milk:
Regular cow’s milk:
Solid foods:
Single-ingredient foods :
Food high in iron:
Commercially prepared baby foods:
Juice for infants younger than 6
months:
Children having juice bottles/cups/box:
Childhood
This is a critical time to instill good dietary habits.
– This is a critical time for instilling good dietary habits.
– At 1 year of age, appetite generally tapers off, growth slows
for now.
– Children still need adequate nutrition.
– The younger the child, the smaller the portions needed.
– If children are offered nutritious foods in pleasant
surroundings and in non-threatening ways.
– The parents should decide which foods to serve at what time;
the child should be able to decide what and how much to eat.
– However this is also the time children test their independence.
Encouraging Good Dietary Habits
Meals at the table at regular times.
Relaxed and enjoyable.
Variety of foods.
Do not force children to eat or clear plates.
Small servings.
New foods.
Nutritious snacks.
Limit sweets.
Encourage physical activity.
Adults are to set good eating habits.
Adolescence
These years are of both physical and emotional growth.
Diets are often filled with kilocalorie-rich and
nutrient-poor snack foods.
Common dietary inadequacies include iron and
calcium.
Many teenagers experiment with alcohol and
drugs, which have detrimental effects on
nutrition.
Obesity is a common problem; weight reduction
diets should be attempted only under the
advice of a physician and with the guidance of
a dietitian.
Adult
With energy, activity decreasing, weight gain
increasing: Nutritional needs start to decrease.
Older Adult Considerations
Aging may affect the eating process.
Aroma and taste of food may change.
Changes in the digestion process.
Kilocalorie needs decrease .
Numerous medications.
Social and mental changes.
Chronic medical conditions.
Nutritional Concerns of Adults
in Long Term Care Facilities
Malnutrition is a common problem among nursing
home residents and profoundly influences physical
health and quality of life.
Residents should be offered familiar foods that taste
good.
Fluids should be offered to residents at all meals and
between meals.
Dehydration is very common and easily corrected in
long term care facilities.
Nurses must understand the value of mealtime as a
pleasant, social experience.
Cultural and personal preferences should be considered.
Many residents need assistance or encouragement.
Lack of adequate staffing play a large role in patient
nutrition.
Many patients are on restricted diets.
Pressure sore due to lack of mobility, and nutrition.
Nutrient-Drug interactions.
Caffeine
Caffeine:
Drug
Central nervous system stimulant and diuretic.
Nervousness
Irritability
Anxiety
Insomnia
Heart arrhythmias
Palpitations
See Caffeine Content of Selected Beverages and
Foods.
Common Medications and Their Effect on
Nutrition
Antacids.
Antibiotics.
Anticoagulants.
Aspirin.
Diuretics.
Laxatives.
Medical Nutrition Therapy
and Therapeutic Diets
These diets are specific nutrition as needed to treat an illness,
injury or condition.
Purpose of Diet Therapy
The dietary prescription is written for one or
more of the following purposes:
Provide the client with nutrients needed for
maintenance or growth.
Prepare a client for diagnostic tests.
Treat the client with a disease or condition.
DIET THERAPY
The treatment of a disease or
disorder with a special diet.
A client must not be given
anything to eat or drink without
an order.
The Vegetarian Diet
Lacto-ovo vegetarians–use dairy
products and eggs but no meat,
poultry, or fish.
Lacto vegetarians–use dairy products
but no meat, poultry, or eggs.
Vegans–avoid all animal foods.
Factors Influencing Diet
Culture
Religion
Socioeconomics
Fads
Superstitions
BASIC
NUTRITIONAL ASSESSMENT
Nutritional status
Height and weight
Meal and snack pattern
Food allergies
Physical activity
Cultural, ethnic, and family
influences
Use of vitamin/mineral supplements
NUTRITION AND HEALTH
Primary nutritional disease–occurs
when nutrition is the cause of the
disease.
Secondary nutritional disease–
occurs as a complication of
another disease or condition.
WEIGHT MANAGEMENT
Based on relationship between
intake and use of kcal.
Overweight: 11%–19% above
Obesity: 20% or more above
Underweight: 10%–15% under
FOOD LABELING
Required on virtually all retail food
products.
Labels must follow the approved uniform
format and use standard serving sizes
and household measurements.
FOOD QUALITY AND SAFETY
Proper storage, preparation,
sanitation, and cooking are
necessary to help prevent or reduce
the risk of food-borne illnesses.
Consistency, Texture, and Frequency
Modifications
Liquid Diets:
Clear Liquids
Full Liquids
Soft and Low-Residue Diets.
High Fiber Diets.
Meal Frequency Modification.
Kilocalorie Modifications
Basal Metabolic Rate (BMR).
High-Kilocalorie and High Protein Diets.
Anorexia.
Kilocalorie-Controlled and Low-Kilocalorie Diets.
Obesity
Measurements of Obesity
BMI
Body Composition
Waist circumference
Treatment of Obesity
Eating Disorders
Anorexia Nervosa:
Self-imposed starvation.
Individuals have an intense drive for thinness,
an intense fear of gaining weight or becoming
fat, and a distorted body image.
Bulimia Nervosa:
Periods of binge eating followed by purging
(self-induced vomiting, emetics, laxatives,
enemas, or diuretics).
Often normal weight or overweight.
Binge / Purge:
Comparison of Eating Disorders
Diagnoses
Body weight and other physical
indicators.
Eating behaviors.
Compensatory behaviors (purging).
Psychologic indicators.
Carbohydrate-Modified Diets
Diabetes Mellitus:
A disease in which the body does not produce or
properly
use insulin.
Insulin convert sugar, starches, and other food into
energy needed for daily life.
Two major types of diabetes:
Type 1
Type 2
Primary goals for medical nutrition therapy:
– Improve metabolic control by achieving
and maintaining optimal blood glucose.
– Provide adequate energy for maintenance
of a reasonable body weight.
– Prevent acute and chronic complications
of diabetes.
– Improve overall health through optimal
nutrition
Carbohydrate intake should be monitored and
controlled.
Diabetic diet tools:
–Exchange lists for meal planning
–Carbohydrate counting
Other nutritional considerations:
–Hypoglycemia: consumption of inadequate
carbohydrates causes the blood sugar to
drop.
Carbohydrate-Modified Diets (continued)
– Dumping Syndrome:
It may occur after surgery in which a portion
or all of the stomach is removed.
– Lactose Intolerance:
Intolerance occurs as a result of a lack of the
digestive enzyme lactase.
Special Diets
Low-residue diet
High-fiber diet
Liberal bland diet
Fat-controlled diet
Sodium-restricted diet
Fat Modified Diet
These diets are beneficial in reducing the risk of atherosclerosis.
Lowering dietary fat may assist in disease treatment and control.
Fat-Controlled Diets:
Limits total fat, saturated fat, and
trans-fatty acids.
Low-Fat Diets:
All fats limited, regardless of saturation.
Lowering Fat/Saturated Fat/Trans Fatty
Acids/Cholesterol
Food Groups:
Choose:
Go Easy on:
Protein/Electrolyte
and
Fluid-Modified Diets
Increased protein facilitate healing.
Defects in protein is seen in liver/renal disease.
Sodium-Restricted Diets:
pg 649 box 21-9
Potassium-Modified Diets:
Fluid-Modified Diets:
Fluid Restrictions
Fluid Increase
Patient Teaching
Fluid restrictions:
Explain the rationale.
Indicated if restriction is temporary or permanent.
Educate, discuss different sources of water.
Teach how to count fluids.
Show the patient how much fluid is allowed.
Suggest ways to alleviate thirst without drinking.
Discuss the consequences of over consumption of fluids.
Nutritional Support
Nutritional Support
Enteral nutrition–includes both the
ingestion of food orally and the delivery
of nutrients through a GI tube.
Parenteral nutrition–the infusion of a
solution of nutrients directly into a vein to
meet the client’s daily requirements.
Tube Feedings
– Administration of nutritionally balanced liquefied
foods or formula though a tube inserted into the
stomach, duodenum, or jejunum by way of a
nasogastric tube or a feeding ostomy.
– Indicated when a patient is unable to chew or
swallow, has no appetite, or refuses to eat.
– Tube feeding used only when all or at least part
of the GI tract is functioning.
– Feeding given continuously or intermittently.
Figure 21-7
Tube feeding
sites.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Nasogastric Tube Feedings
Checking for placement of a feeding tube before
administering medication or tube feeding is critical
to safe patient care.
Tube may be accidentally placed in the lung,
esophagus, or even the stomach when it should
be in the small bowel.
To test, use chest x-ray, test pH of aspirated fluid,
or use auscultatory method.
Administering
Nasogastric Tube
Feedings
Skill 21-1: Step 10a(1)
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Administering nasogastric tube feedings.
Skill 21-1: Step 10a(2)
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Administering nasogastric tube feedings.
Skill 21-1: Step 10b
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing [6th ed.]. St. Louis: Mosby.)
Administering nasogastric tube feedings.
Administering nasogastric tube feedings.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Administering nasogastric tube feedings.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Parenteral Nutrition Support
– Parenteral nutrition (hyperalimentation):
Intravenous feedings.
May be administered through peripheral veins.
– Total parenteral nutrition (TPN):
Administration of hypertonic solution into a large
central vein.
Composed of glucose, amino acids, vitamins, minerals,
and electrolytes; fats also given as a supplement to the
main formula.
Indicated for the patient with a nonfunctioning or
dysfunctional GI tract.
Figure 21-8
(Courtesy of Rolin Graphics.)
Central venous catheter placement during administration of
parenteral nutrition.
Nursing Assessment
Must be performed in a logical fashion
and should include a nutritional
history, physical examination, and the
results of laboratory tests.
Nursing Diagnosis
Imbalanced nutrition:
– Less than body requirements
– More than body requirements
Risk for imbalanced nutrition: more than
body requirements
Disturbed body image
Ineffective breastfeeding
Impaired dentition
Deficient knowledge (specify)
Impaired oral mucous membrane
Pain
Feeding self-care deficit
Chronic low self-esteem
Risk for impaired skin integrity
Planning / Outcome
A plan should be formulated by the
nurse and client to achieve mutually
agreed-upon goals.
The plan is individualized to meet
the client’s specific needs.
Implementation
Interventions to accomplish the goals
may include diet therapy, assistance
with meals, weight and intake
monitoring, and nutritional support.
Questions ?