objectives Anatomy of the alimentary canal Explanation of nutrition Food pyramid Therapeutic diets Cultural and religious concerns Feeding the dependent patient

Gastrointestinal system and nutritional needs of patients

The GI system is responsible for the physical and chemical breakdown of food. The food is broken down so it can be taken into the blood stream and used by the body, cells, and tissues. The alimentary canal begins at the mouth and ends at the anus.

The alimentary canal: A) begins at the mouth and ends at the colon B) begins at the esophagus and ends at the large intestines C) begins at the mouth and ends at the anus D) is part of the panama canal

mastication The teeth breakdown the food by. chewing and grinding the food. The tongue, a muscular organ, contains the taste buds necessary to taste: sweet, salt, sour and bitter.

The soft and hard palate are the roof of the mouth and are responsible for separating the mouth from the nasal cavity. The uvula hangs down from the soft palate and helps prevent food from entering the nasopharynx during swallowing

Chemical breakdown 3 pairs of salivary glands: The parotid, sublingual and submandibular glands produce saliva. Saliva lubricates the mouth during speech and chewing. Saliva also produces an enzyme called salivary amylase which starts the breakdown of carbohydrates into sugar.

Amylase is responsible for : A) breaking down carbohydates for fat storage B) breaking down protein for healing C) breaking down carbohydrates D) breaking down fats

What happens to the taste of a carb treat when you let the carb treat set in your mouth for 30 seconds breaking down the sugar?

After the food is chewed and chemically broken down it is called a bolus. When the bolus is swallowed it enters the pharynx(throat) The epiglottis is a flap that covers the larynx preventing food from entering the lungs.

The esophagus is the muscular tube dorsal( behind) the trachea. Students: Feel your trachea

The food goes down the esophagus through peristalsis The food goes down the esophagus through peristalsis. The cardiac sphincter closes after food enters the stomach. People with acid reflux disease have problems with the cardiac sphincter. Pepcid AC, protonix,tagament, mylanta are common anti-acid meds

What covers the trachea so food does not enter it? A) epiesophagus B) epiglottis C) tracheaglottis D) uvula

Food stays in the stomach 1-4 hours Food stays in the stomach 1-4 hours. The pyloric sphincter prevents the food from leaving too soon. It is a muscular sphincter between the stomach and small intestine.

While the food is in the stomach HCL kills bacteria,facillitates iron absorption and activates the enzyme pepsin. Pepsin starts protein digestion. The enzyme lipase is in the stomach which starts the breakdown of fat.

The cardiac sphincter closes after food enters: The stomach The espophagus The pharynx The heart

When food leaves the stomach it is in a semi fluid material called chyme

Accessory organs Pancreas The pancreas is a large, elongated gland lying posteriorly to the stomach (fig. 1-53). As discussed earlier in "The Endocrine System," the pancreas has two functions: It serves both the endocrine system and the digestive system. The digestive portion of the pancreas produces digestive juices (amylase, proteinase, and lipase) that are secreted through the pancreatic duct to the duodenum. These digestive juices break down carbohydrates (amylase), proteins (proteinase), and fats (lipase) into simpler compounds

Which enzyme is involved in protein breakdown? A)pepsodent B) pepto bismol C) preperation H D)pepsin

Small intestine 20 feet long and one inch wide. It is divided into 3 sections Duodenum is the first 9 inches Bile from the gall bladder and liver and pancreatic juice are secreted into the duodenum creating more chemical breakdown.

The liver is the largest organ

It metabolizes carbohydrates, fats, and proteins preparatory to their use or excretion. � It forms and excretes bile salts and pigment from bilirubin, a waste product of red blood cell destruction. � It stores blood; glycogen; vitamins A, D, and B12; and iron. � It detoxifies the end products of protein digestion and drugs. � It produces antibodies and essential elements of the blood-clotting mechanism.

Gallbladder The gallbladder is a pear-shaped sac, usually stained dark green by the bile it contains. It is located in the hollow underside of the liver (fig. 1-53). Its duct, the cystic duct, joins the hepatic duct from the liver to form the common bile duct, which enters the duodenum. The gallbladder receives bile from the liver and then concentrates and stores it. It secretes bile when the small intestine is stimulated by the entrance of fats.

Small intestines The jejunum is 8 feet in length and the ileums 12 feet and it connects to the large intestines via the cecum. The ileocecal valve separates the small and large intestines. Absorption of nutrients occur in the small intestines.

What fluid is secreted into the duodenum? A) bile B) pancreatic juices C) dopamine D) both a and b

Intestinal juices in the small intestine include maltase, sucrase,and lactase which break down sugar into simpler forms. Peptidases completes the digestion of protein

The walls of the intestine are lined with finger like projections called villi. The villi contain blood capillaries and lacteals. They carry the nutrients to the liver, where they are either stored or used by the body cells

What is the largest gland? A) liver B) heart C) small intestine D) pineal

The large intestine 5 feet long 2 inches wide. Functions: absorbtion of water, synthesis of vit k. elimination of waste. Cecum contains the appendix. Colon ascending colon, transverse colon, Descending colon. The descending colon is on the left side and connects to the sigmoid colon

The rectum is the final 6-8 inches of the large intestine and is storage for indigestible and waste. It exits the anus

Feeding the dependent patient Wash your hands Provide a bib Give ½ teaspoon at a time. Alternate with fluids Provide a relaxed atmosphere Note personal preference ,such as eating all of one food at one time, mixing food ect

Septo syringe feeding 10-15 cc at a time, side of mouth 30cc equals one ounce

Religious and cultural beliefs Christian science: no tea, coffee, or alcohol

catholic No food one hour prior to communion No meat during lent on Fridays

Muslims Muslims: no pork

7 day Adventist no pork or caffeine

How many cc equal an ounce? B) 30 C) 40 D) 50

Special diets Clear: post-op, water, tea, coffee, jello, popsicles, clear broth

Full liquid Advance from clear liquid Custard, strained soup, ice cream, Herbert

bland For ulcers, gallbladder disease GI disorders. Lean meat, white flour, refined cereal, pudding, pasta, strained vegetables

Regular diet

NPO Nothing by mouth

Intake and output Everything taken in po, IV, IM, NG tube, central line, G tube is all counted. Output includes, anything liquid: urine, emesis, diarrhea Average intake 2000-2500 cc Output 1500-2000cc Output should be close or equal to intake

nutrition 64.5 % of american adults are overweight. The following diseases are related to poor nutrition: hyperlipidemia, cardiovascular disease, type 2 diabetes, osteoporosis,hypertension,obesity, cancer, Gallbladder disease, joint pain.

CDC powerpoint on obesity

NPO means which of the following? A) nothing by mouth B) nothing by GI system C) no protein only D) nearly per os

How do I eat in a healthy way? Follow the new food pyramid which includes the following and moderate exercise.

Grains 6 ounces a day One ounce includes: one slice of bread ½ cup of rice, cooked pasta, cooked cereal, 1 cup dry cereal 5 crackers 6 inch tortilla

Vegetables 2.5 cups 1 cup of fresh vegetables 2 cups of lettuce =1 cup 2 medium carrots -1 cup 1 large ear of corn= 1 cup 1 large potatoe=1 cup

Fruit 2 cups ½ cup of dried fruit =1 cup of fruit 1 cup = banana, apple, grapefruit,peach, Pear, 8 large strawberries

Oil 6 tsp 1 tsp = 1/3 ounce of nuts 1.5 tsp peanut butter 1 tablespoon of salad dressing 3 tsp=1 table spoons

Milk 3 cups The following = 1 cup 1.5 oz of natural cheese 2 oz of processed chese 1.5 cups of ice cream 1 cup of milk or yogurt

Meats and beans 5.5 oz ¼ cup of beans 1 egg 1 tablespoon of peanut butter ½ oz nuts ½ cup of split pea soup,lentil or bean soup

How many cups of vegetables should you eat each day?

The doctor of the future will give no medicine but will interest his pt in the care of the human frame, in diet and in the cause and prevention of disease. by Thomas Edison

A nutrient is a substance that is ingested, digested, absorbed, and used by the body. They are necessary for all body functions and levels of activity

6 essential nutrients Carbohydrates( 4 calories per gram) Protein( 4 calories per gram) Fat ( 9 calories per gram) Vitamins ( no calories) Minerals ( no calories) Water ( no calories)

Nutrients are in proteins, carbohydrates, and fats

One gram of fat supplies the body with 9 calories

1 gram of carbs equal 4 calories

One gram of protein equals 4 calories

Which of the following is ingested, digested, absorbed and used by the body? A) nutrients B) calories C) vitamins d) minerals

Vitamins and minerals are in the carbs, protein and fat

carbohydrates 45-60 % of our diet should be carbs. Individual with metabolic disorders such as diabetes should stick with the lower range. To determine how many grams of protein you should have complete the following question.

If you eat a 2500 calorie diet and 60 % of your diet is carbs, how many grams of carbs should you have each day? Formula: calories X60% Divide that number by 4 since there are 4 calories in each gram of carb

2500 calories X60%= 1500 calories 1500 calories divided by 4= 375 grams of carbs per day

What are carbohydrates?

Fat and carb Give the body fuel for energy

carbohydrates Carbohydrates are the sugars and starches found in food.they are made from carbon and oxygen molecules. 45-60%of your diet should come from carbs. There are 2 general types of carbs:simple and complex

The cells must have glucose for energy and to survive. Glucose that is not used immediately is converted to glycogen, a form of starch stored in the muscles and liver or it is converted to fat and stored until needed

The main function of carb’s is to provide energy The main function of carb’s is to provide energy. We need 130 grams of carbs for normal brain function. People on the atkins diet often feel fuzzy due to the lack of carbs. Carbs are protein sparing so the body will use the carbs instead of breaking down muscle fibers for energy

Simple carbohydrates also known as monosaccharides and disaccharides Simple sugars like fructose and glucose( are in fruits and vegetables) Milk has lactose(some people are lactose intolerant) Sucrose( found in the sugar cane) which is refined to produce table sugar Glucose: goes directly into the blood stream to provide quick energy. All other sugars must be converted to glucose before the body can use it.

Examples Honey, soda, sports drinks, candy, cookies, syrup, molasses.

How many calories are in one gram of protein? B) 4 C) 12 D) 8

Complex carbohydrates also known as polysaccharides Starches are complex carbohydrates that are made up of many units of glucose or other sugars which form long chains. The body must break down these long chains into simple single units of glucose. Starches provide energy over a longer period of time. Simple sugars give short time energy and complex carb give longer energy but it takes longer.

examples Whole grains, cerals , brown rice, pasta, pototoes, legumes , vegetable , fruit

Carbs give you energy, but will turn to fat if it is not used Carbs give you energy, but will turn to fat if it is not used. A high carb diet stimulates the appetite and may create mood swings. We need balance in our diet.

Dietary fiber A complex carbohydrate which comes from non digestible parts of plants. Soluble and insoluble fiber. Insoluble: absorbs water and provides bulk. Whole grains, skins, and seeds of fruits and vegetables Soluble: assist with the removal of waste. Oat bran, apples, carrots, beans and barley

Which of the following are examples of simple carbohydrates? A) honey B) rice C) lasagna D) water

We need 21-38 grams per day. Adequate fiber decreases colon cancer, heart disease, type 2 diabetes, constipation and hemorrhoids

Fiber sources Bran cereal, plums, strawberries, legumes whole grain

Carbs that are in the blood is called glucose Carbs that are in the blood is called glucose. Our glucose levels should be between 70-99. We have 5 grams of carbs in the bloodstream stored as glucose. 400 grams stored as glycogen in the muscles. 100 grams stored in the liver as glycogen

fats Fats contains the most concentrated form of energy.you need a small amount of fat. Fat or lipids provide twice as much energy gram per gram to carbs. Fats are important parts of body tissue, used to transport and store vitamins and minerals, and give food flavor.

Concerns about fat We need 25% of our calories from fat but most Americans consume 40% of their calories from fat. 30% or less of the calories should be from fat. Eg cookie has 100 calories but 3 grams of fat

Saturated fats Solid at room temperature. Butter, shortening, margarine,coconut or palm oil They contain the maximum number of hydrogen molecules. Increase heart disease, blood vessel disease, obesity and some cancers

Unsaturated fats Liquid at room temperature Olive oil, peanut oil, fish oils such as omega 3, vegetable oil, soybean oil, sunflower oil, Unsaturated fats are better than saturated. They have less hydrogen ions

Trans fats Trans fats create free radicals and form LDL cholesterol. Anything that says hydrogenated is a trans fat

cholesterol Cholesterol is a waxy fat like substance created by the body.cholesterol is part of the membrane of the cell and is used by the body to form vitamin D and other hormones. Cholesterol is found in foods that come from animal like butter, eggs and meat. The body produces cholesterol in the liver so we do not need additional cholesterol from our food sources.

LDL Cholesterol sticks to the vessel walls leading to arteriosclerosis. HDL the healthy cholesterol removes cholesterol from the cells and brings it to the liver to excrete or recycle. Exercise increases HDL

protein The body needs protein to build and repair body tissue. Essential amino acids: there are different amino acids. 9 are essential which means it must be supplied by the food you eat. The other 11 AA your body will produce.

Complete vs. incomplete protein Complete proteins are essential proteins which come from animals: milk, meat, cheese, poultry, and fish. Incomplete proteins are lacking some of the AA.you can make completes by combining: Beans and rice or peanut butter on wheat bread.

Vitamin Water soluble: are excreted in the urine in 2 hours Vitamin B1 thiamine B2 riboflavin B3 niacin B6 pyrdoxine B12 Folic acid

C ascorbic acid

How many essential proteins must we get from our food? B)9 C)10 D)11

Fat soluble vitamins A D E K High levels can be deadly

Vitamin trivia You should take a multi vitamin daily! Take vitamin C And iron at different times of the day for they compete for body cells and produce free radicals Does your vitamin have both iron and vit c?

Take folic acid and vitamin E if your multi vitamin does not have 100% of the RDA. All sexually active females must take folic acid to prevent spina bifida

Cancer fighters Broccoili: prevents breast and colon cancer Tomatoes: has antioxident: lycopenes: Olive oil Red grapes Carrots Fish bran

Green tea herbs

dieting Small frequent meals 1200 or more calories Lose 2 pounds per week Then do not go back to your old eating habits

Be mindful and appreciative of what you eat. Focus on what you are eating, savor each bite. Don’t think about the next bite. Put your fork down. Chew your food for several chews don’t just put it in your mouth and swallow

Stop eating when you are full Stop eating when you are full. It takes 20 minutes for your stomach to send the message to stop eating. drink water before you eat. Smell bananas or green apples…it decreases your appetite

Graze…eat a small amount of healthy food every 2 hours instead of 3 big meals Keep healthy foods around you.

What is a safe amount of weight to lose per week? A) 2 pounds B) 4 pounds C) 6 pounds D) 5.5 pounds

water 64 ounces of water a day is needed for healthy cells Hunger pangs,mentally lethargy and fatigue can all be helped with an 8 ounce glass of water. Caffeine is dehydrating and keeps the water out of the cell

Think about what you want to look and feel like. Think positive…… I will be fit ,trim and happy

calorie The amount of energy produced when the body burns fat. 3500 calories in one pound

15 calories per body pound is needed to maintain weight without movement. Multiple your weight by 15

How many calories do I need to lose X pounds? weight loss equation 655 plus (4.4 x your goal weight in pounds) plus (4.6 x your height in inches) minus 4.7 x your age in in years equals base calories. Multiple this number by 1.2 if you get little or no exercise By 1.3 if you are active. Loss of 1-2 pounds per week

Hippocrates , the father of modern medicine states: “Let food be your medicine and medicine be your food”