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
Dietary intake and food preparation
Unpleasant symptoms
Allergies
Taste, chewing and swallowing
Appetite and weight
Use of medications
Nutritional health-care Team
MD
Nurse
Social Worker
Physical Therapist
Occupational Therapist
Speech Pathologist
Pharmacist
Essential Nutrients Regulatory Nutrients
Water
Carbohydrates
Proteins
Lipids
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 storedStored 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:
Lactose
Cellulose
DIETARY FIBER -
Helps regulate blood
sugar
May reduce risk of
hyperlipidemia
May reduce risk of some
cancers
Protein
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)
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 water-
insoluble 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
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
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 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
maintenancedeficiency-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
synthesisdeficiency-RBC hemolysis
Whole grains, nuts
Vitamin K: function-formation blood clotting
proteinsdeficiency- 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 earths crust, arent 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 transmissiondeficiency-tetany,
osteoporosis
Phosphorous: bones, acid-base
balancedeficiency- 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
formationdeficiency-anemia
Iodine: thyroid hormonesdeficiency-
goiter
Zinc: wound healing deficiency-
impaired immune system
Fluoride: teeth/bonesdeficiency-
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
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)
Height (inches) squared
X 705
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
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
Hemoglobin
Transferrin


Nursing Dx
Imbalanced nutrition: less than body
requirements R/T NPO status AEB
height 56 wt 105 lbs., pt. states
Ive 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
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
NPO
Clear liquids-see
through (broth,
apple juice)
Full liquids foods
that turn to liquid at
room temp.
(shakes, milk)
Soft easily chewed
and digested
Low residue- no seeds,
raw vegetables or
fruits, whole grains
High fiber- raw fruits,
grains, vegetables
Sodium restricted:
Mild 2 gram Na/day
Moderate 1gram
Strict 500mg
Severe 250 mg
DASH Dietary Approaches
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 placementcheck 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
line
Partial parental nutrition (PPN)..PICC
line

Evaluation
Use established outcomes to evaluate the
pts response to care
Pt understanding of therapeutic diet
Reassess S&S associated with altered
nutrition (wt, intake, lab results)
Determine pts satisfaction with nutritional
therapy
Summary
Nurses role, to understand nutrients and
how they affect nutrition
Various factors affect ones nutritional
status
Interventions include numerous diets,
assisting with feeding, monitoring and
teaching
Nutrition can also be administered
enterally or parentally