 Normal growth  Tissue maintenance  Tissue repair/recovery  Treatment of disease

 Maintain immune system  Prevent medical problems  Maintain normal temp  Produce enzymes and hormones

 Intake of food/fluids  Mechanical Digestion  Chemical digestion of starches begins

 Passageway from the mouth to the stomach  Peristalsis propels food forward

 Turns food into chyme  Adds HCL  Mechanical and chemical digestion continues  Food stays for 1-4 hours

 Simple carbohydrates 1hr  Complex carbohydrates 3hr  Protein 5hr  Fats 7hr  Rationale for a variety of foods in % of intake

 Chemical digestion  Bile and enzymes are added  Digestion completed  Absorption of nutrients occurs

 Storage of wastes  Absorption of water  Elimination  Synthesis of Vitamin K

 Psychological State-fear, anxiety  Bacterial action  Food processing-whole grain, raw, fried, cooked

 Substance which contains elements necessary for body function  6 classes: CHO, CHON, Fat, H2O, Minerals, Vitamins

 Provide energy  Primary plant foods  May contain fiber  Simplest form is glucose  Anabolism  Catabolism  Converted to adipose

 Amino acids  Tissue growth/repair  Complete proteins  Incomplete proteins  Nitrogen balance

 Fats and oils  Concentrated energy  Triglycerides  Provide insulation  Maintain temperature  Fat-soluble vitamins

 Most essential nutrient for survival  Essential for cells  Sources--eating, drinking, metabolism

 Sodium: Less than 3000mg  Cholesterol: Less than 300mg  Fat: Less than 30 %  Fiber: Approximately 30 Grams  Fluids: 3000ml / 24 hour

 Fat soluble--A, D, E, K  Water soluble-B-complex, C  Regulate metabolic functions within cells  Contain antioxidants

 Inorganic elements  Serve as catalysts  Essential for good health  Calcium, phosphorus, magnesium

 Infants: double wgt 4-5 mo. Not able to digest or metabolize many foods  Toddlers & pre-schoolers: need increase in protein r/t body wgt.  School age + adolescents: generally have good appetites. Need healthy selection ed.  Adults: Fruits, veg, whole grain & portion control

 May have fixed income  May not be able to go out and shop  Decrease in taste buds  Loss of teeth, poor fitting dentures  Don’t enjoy eating alone

 Health  Socio - Economic status  Psychological state  Culture/religion

 Personal preferences  Misinformation-food fads  Alcohol and drug use  Age and life-style  Alcohol = 7calories/gram

 Hgt & wgt I&O trends  Body composition Edema  Condition of skin, teeth, hair  Dietary history Turgor  Dietary diary Anthropometry  Calorie count Stool characteristics

 Albumin-role in F&E balance  Pre-albumin-more reliable  Transferrin-non-hem iron->when iron  Hbg-O2 carrying capacity < blood loss  BUN = hydration and Creatinine

 2000 calorie diet 60% carbohydrate 20% protein 20% fat calories 2000X60%=1200/4cal per g=300gram CHO 2000x20%= 400/4cal per g=100gramCHON 2000x20%= 400/9cal per g=44grams Fat

 Represents allowances of essential nutrients by age and category, inclusive of weight and height.  Represents 98% of people in general good health  55-60% carbohydate 12-20% protein <30% fat

 Anyone with problems with I & O, digestion and absorption of nutrients ◦ Anorexia nervosa ◦ Bulimia --Impaired mobility ◦ Chemotherapy --Lengthy NPO ◦ Chronic illness ◦ Extensive surgery

 Most reliable indicator is WEIGHT Intake and output are very important and must be accurate

 Provide rest to a body part  Adapt to client’s ability to eat swallow, digest, absorb, or metabolize nutrients  Weight loss or gain  Maintain nutritional status  Correct deficiencies

 Consistency/texture  Frequency of feedings  Number of calories  Specific nutrients  Fluid volume

 Tea, broth, jello, water  Liquids you can see through  Nutritionally inadequate

 Foods that are liquid at body temperature  May be nutritionally adequate if planned carefully

 Foods which are easy to chew and to digest  Mechanical soft/pureed

 Non-irritating foods  Chemically  Thermally  Mechanically

 Residue has to do with fiber  Hi=increase peristalsis  Low-decrease peristalsis  Regulates the volume of fecal output

 Sodium restricted: reduces fluid retention and allows heart to work less  Low fat or cholesterol: reduces the plaque formation in blood vessels, limiting CAD

 Offer bathroom  Wash face/hands  Oral care  Glasses/hearing aids  Position of comfort prior to food served  Reinforce importance of intake

 Serve food in pleasant social setting  Prepare tray  Place in reach and in visual field  Encourage social interaction  Assist with feeding if necessary  Know precautions  Protect clothing with apron-not bib

 Allow client to empty mouth before putting more food in  Encourage client to direct speed/order  Be at eye level/face to face  Allow for rest periods  Avoid heaping food on utensils

 Record accurate intake and output  Note % ¼, ½,¾,or 100%  Provide oral hygiene  Offer fluids or supplements as ordered thru shift

 Feedings administered through a tube directly into the stomach or small intestine  Naso-gastric tube  Gastrostomy tube  Jejunostomy tube

 Comatose clients  Severe reflux disease  Paralysis of muscles used for swallowing  Obstruction  Weakness

 X-ray verification  Aspirating gastric contents  Instilling air through tube while auscultating with a stethoscope  Ask client to speak

 Check placement q 4 h and prn  Check residual q 4 h and prn  Keep HOB up 30 degrees  Abdominal assessment, temp, lung sounds q shift and prn, stooling  Report N/V

 Change bag q 24 hrs  Measure and record I&O q 8 h  Flush tube with water -- institutional policy re: meds and feedings  Give meds individually!! Flush between each med  Observe rate of flow

 Provide hydration  Administer meds  Access circulatory system  Provide electrolytes  Give blood

 Observe rate and flow and correct solution  Record I&O  Check insertion site  Assess client’s fluid balance

 Inflammation of a vein  Red streak  Warmth  Pain  Edema  Fluid infuses readily  Good blood return

 Skin pale in area  Skin cool  Edema  Firm to touch  Feels “tight” or “burns”  Infuses sluggishly  No blood return

 Contains all necessary nutrients  AKA Hyperalimentation  Given via central line

 Assess IV site q shift, dressing  Weigh daily  Record I&O  Note infusion rate/ correct solution  Assess fluid balance  VS q 4 hr. Accu checks

 Electrolytes: ions and carry electric charge when dissolved in fluid. + =cations=NA, K, Ca, Mg. ---anions=Cl, HCO3  Minerals: ingested compounds, help regulate body functions  Cells: functional basic units of all living tissue. Cells within fluid=R and W blood cells

 Intracellular: contained within each cell =40% of body wgt  Extracellular: located outside the walls of the individual cells and is divided into: ◦ Interstitual fluid: tissue fluid (edema) ◦ Intravascular fluid: within blood vessels ◦ Transcellular: CSF, digestive juices, synovial

 Diffusion: Solutes move from an area of higher concentration to an area of lower concentration  Osmosis: movement of (solvent) water from a solution of lower concentration to an area of greater concentration

 Active transport: Solutes are moved across a semipermeable membrane with a source of energy. Requires metabolic activity and energy expenditure.  Filtration: process by which H20 & diffusible substances move together in response to fluid pressure

 Decrease in the extracelluar fluid (dehydration), n/v, diarrhea, hemorrhage ◦ S/S: Dry mucous membranes, decrease in BP, increase in heart rate, elevated temp, decrease in skin turgor, sunken eyes, diminished urine output, rapid wgt loss, slow vein filling, confusion ◦ Tx: IV, antiemetics, stop diarrhea, tx cause

 Increase in extracellular fluid (hypervolemia or anasarca) ◦ Renal or liver failure, secondary to ds of the CV system (CHF), protein deficiency, hormonal or steroid therapy, excessive Na ◦ S/S: Dependent edema, rapid wgt gain, HTN, polyuria, JVD, rales, ascites, orthopnea, bounding pulse

 Nursing Tx: HOB elevated ◦ Frequent Vital Signs ◦ Daily wgt I & O ◦ Sodium restriction Lung sounds ◦ Skin care TCDB q 2 h Tx: 02, IV therapy, fluid restriction, diuretics, low Na diet, antiembolic hose

 K: intracellular fluid mEq/L. ◦ Nerve stimulus conduction, muscle activity ◦ Abnormal levels may cause cardiac irregular  Na: regulates fluid balance mEq/L.  Ca: generally combines with phosphorus to form the mineral salts of the teeth and bone mEq/L. Need for normal muscle activity

 Mg: necessary for neuromuscular excitability