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Nutrition Powered By Docstoc
					Stressors that Affect
FALL 2009

Sharon Niggemeier RN MSN
• Nutrition is interaction between an
  organism and the food it consumes
• Food & eating is a basic need, affects
• 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
    Nutritional health-care Team
•   MD
•   Nurse
•   Social Worker
•   Physical Therapist
•   Occupational Therapist
•   Speech Pathologist
•   Pharmacist
Essential Nutrients   Regulatory Nutrients

 •   Water            • Vitamins
 •   Carbohydrates    • Minerals
 •   Proteins
 •   Lipids
• 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: simple or complex
• Digested by enzymes
• Absorbed in small intestine
• Metabolized into glucose which is
  used for energy or stored…Stored as
  either glycogen or fat
• Function: provide energy, spare
          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
• What are some other functions of
  carbohydrates in our bodies?
                           DIETARY FIBER -
                           Helps regulate blood
Laxative effects of:       sugar
Lactose                    May reduce risk of
Cellulose                  hyperlipidemia
                           May reduce risk of some
•   Proteins: composed of amino acids
•   Digested by enzymes (proteolytic)
•   Absorbed in small intestine
•   Metabolism includes:
•   Anabolism=Catabolism: Nitrogen
• 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: 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)
• 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
• Lipoproteins - made by the body to move water-
  insoluble lipids (such as cholesterol) thru the
• 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
•   Total Cholesterol      < 200
•   Triglycerides          < 150
•   LDL                    < 100
•   HDL                    > 40 Male
                           > 50 Female
• Elevated Blood Lipid Levels
  (Hyperlipidemia) = increased risk for CHD,
  Hypertension, Stroke, MI
• 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… deficiency-
  rickets, 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
• More prone to toxicity; stored by body
• 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
• 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,
• Phosphorous: bones, acid-base
  balance…deficiency- muscle weakness
• Magnesium: bones, metabolism ...deficiency-
  muscle pain, poor cardiac function
• Potassium: f/e balance, acid-base balance…
  deficiency-muscle cramps , irregular ht. rate
   Microminerals          text review

• Iron: hemoglobin
• Iodine: thyroid hormones…deficiency-
• Zinc: wound healing … deficiency-
  impaired immune system
• Fluoride: teeth/bones…deficiency-
  discolored 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
                  • Rule of thumb
• Ideal body        Women: 100 lbs lst 5ft
  weight IBW =              5 lbs/inch over 5ft
                    Men: 106 lbs lst 5 ft
  balance of             6 lbs/inch over 5ft
  energy used     • Standardized charts
  by the body       Overweight = 10% > chart
  and intake of     Obese = 20% > chart
  nutrients       • Body mass index(BMI)
                    18.5 – 24.9 healthy
                    > 25 = overweight
                    > 30 = obese
                    > 40 = morbidly obese
Factors Affecting Nutrition
              • Developmental
              • Gender
              • Ethnicity &
              • Food beliefs
              • Preference
              • Religion
Factors Affecting Nutrition
• Lifestyle
• Medications &
• Heath status
• Advertising
• Alcohol
• Psychological
Adequate Nutrition
         • Food Guide
         • Daily reference
         • Food Labeling
         • Dietary guidelines
Food Guide Pyramid
                       6 servings
         Vegetables    3-5 servings
         Fruits        2-4 servings
         Milk, Cheese 2-3 servings
         Meat, Fish, Poultry, Nuts
                       2-3 servings
         Fats/Oils/Sweets sparingly
          Dietary Guidelines
•   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
•   Nursing history
•   Physical exam
•   24-hr. recall
•   Food records
•   Anthropometic data
•   Lab tests – Albumin & Prealbumin
           Nursing Dx
• Imbalanced nutrition: less than body
  requirements R/T NPO status AEB
  height 5’6’’ wt 105 lbs., pt. states
  “ I’ve never been this skinny before,
  my clothes are hanging off of me”
• Impaired dentition R/T nutritional
  deficits AEB dentures not fitting
Planning- outcome criteria
•   Pt. will:
•   Attain and maintain ideal body weight
•   Eat a variety of foods at each meal
•   Promote healthy nutritional practices

• Monitoring food
• Assist with
• Stimulate
• Teaching
         Diet Restrictions
• NPO                    • Low residue- no seeds,
                           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
  (shakes, milk)            – Strict 500mg
• Soft –easily chewed       – Severe 250 mg
                            – DASH Dietary Approaches
  and digested                to Stop Hypertension
         Diet Restrictions
• Calorie         • Food
  restrictions      textures:Thick it
                  • Thin
• Diabetic diet   • Nectar-like
                  • Honey-like
• Cholesterol     • 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   • Long term use

                   • Gastrostomy
• Nasogastric
                   • Percutaneous
• Nasointestinal     endoscopic
      Enteral Formulas
• Many types of formulas
• Administered continuous or
• 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:

•   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
• Partial parental nutrition (PPN)..PICC
• Nurses role, to understand nutrients and
  how they affect nutrition
• Various factors affect one’s nutritional
• Interventions include numerous diets,
  assisting with feeding, monitoring and
• Nutrition can also be administered
  enterally or parentally

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