Fundamentals of Nursing Nutrition

Physiology of Nutrition  Nutrition is the process by which the body metabolizes and utilizes the nutrients from food.  Nutrients are digested by the GI system and then absorbed by the blood or lymphatic system, and transported to the body’s cells.

Physiology of Nutrition  Digestion is the process by which ingested foods are broken down in the GI tract to smaller segments in preparation for absorption.  The end products of digestion are monosaccharides (simple sugars), amino acids, glycerol, fatty acid chains, vitamins, minerals, and water.

Physiology of Nutrition  Absorption : is the process by which the end products of digestion pass through the epithelial membranes in the small and large intestines into the blood or lymph systems.

Physiology of Nutrition  Metabolism is the aggregate of all chemical reactions and processes in every body cell, such as growth, generation of energy, elimination of wastes, and other bodily functions as they relate to the distribution of nutrients in the blood after digestion.  Metabolic rate refers to the rate of heat liberation during chemical reactions.

Metabolism  Energy A calorie is the unit of measurement used to express the quantity of energy released during metabolism. Energy is expressed in terms of kilocalories. Basal metabolic rate (BMR) represents the energy needed to maintain essential physiological functions.

Metabolism  Excretion Digestive and metabolic waste products are excreted through the intestines and rectum. Other excretory organs are the kidneys, sweat glands, skin, and lungs.

Nutrients  Water  Vitamins  Minerals  Carbohydrates  Proteins  Lipids

Nutrients  Water Accounts for 60% to 70% of an adult’s total body weight and 77% of an infant’s weight. Water and electrolytes are substances that must be acquired from the diet. Body water requirements are met through consumption of liquids and foods and the oxidation of food.

Nutrients  Vitamins Organic compounds that aid in the regulation of cellular metabolism and assist in the biochemical processes that release energy from digested food Vitamins are classified as fat-soluble or water-soluble.

Nutrients  Carbohydrates Organic compounds composed of carbon, hydrogen, and oxygen Primary source of energy for the brain and the preferred fuel for the body

Nutrients  Carbohydrates Monosaccharides (simple sugars) include glucose, galactose, and fructose. Disaccharides (double sugars) include sucrose, lactose, and maltose. Polysaccharides (complex sugars) include glycogen, cellulose (fiber), and starch.

Nutrients  Proteins Organic compounds that contain carbon, hydrogen, oxygen, and nitrogen atoms combine to form proteins. Essential for almost every bodily function.

Nutrients  The end products of protein digestion are amino acids which categorized to:  Nonessential amino acids: can be synthesized in the body.  Essential amino acids must be ingested in the diet because they cannot be synthesized in the body.

Nutrients  Lipids (fats) Organic compounds are the only essential nutrients that cannot mix with water and therefore, must be emulsified by molecules to be absorbed. Fats are lipids that are solid at room temp. Oils are lipids that are liquid at room temp.

Nutrients  Most Important Lipids Triglycerides are composed of three fatty acid cells attached to a glycerol molecule. Phospholipids are composed of one or more fatty acid molecules and one phosphoric acid radical; they usually contain a nitrogenous base. Cholesterol is produced by the body and is considered a fat; it is also found in whole milk and egg yolk.

Promoting Proper Nutrition The Food Guide Pyramid outlines six groups of food and the number of servings based on dietary guidelines and the basic four food groups.

Promoting Proper Nutrition  Societal Concerns One-third of the U.S. population is considered overweight. Obesity is becoming an epidemic. Undernutrition is a specific problem for the elderly and for people with eating disorders.

Weight Management  Overweight is an energy imbalance in which more food is consumed than needed.  An underweight person expends more calories than are consumed.

Factors Affecting Nutrition  Age  Lifestyle  Ethnicity, Culture  Religious Practices  Economics  Gender  Medication

Assessment  Nutritional History 24-hour recall Difficulty eating Changes in appetite Diet history & preferences Changes in weight General health & medical history

Assessment  Physical Examination Intake and Output (I & O) Anthropometric Measurements - Skinfold measurements: used to determine fat stores -Mid-upper-arm circumference: measures fat, muscle & bone -Abdominal-girth measurement

Assessment  Measuring the mid- upper-arm circumference

Nursing Diagnoses  Imbalanced Nutrition: Less Than Body Requirements  Imbalanced Nutrition: More Than Body Requirements or Risk for More Than Body Requirements

Other Nursing Diagnoses  Activity Intolerance  Acute Pain  Ineffective Health Maintenance  Constipation  Impaired Swallowing

Implementation  Monitoring Weight and Intake  Diet Therapy Nothing by Mouth (NPO) Clear-Liquid diet Full-Liquid diet Soft diet Diet as tolerated

Implementation  Diet Therapy Low-residue High-fiber Liberal bland Fat-controlled Sodium-restricted Lactose intolerance

Implementation  Assistance with Feeding  Providing Nutrition Support  Nutrition Support Teams

Implementation  Providing Enteral Nutrition: is an alternative method to give adequate nutrition used when the client is unable to ingest foods or the GI tract is impaired. Feeding tubes (e.g nasogastric tube) Insertion of enteral feeding tubes Enteral formulas

Enteral Feeding Routes

Implementation  Administration of Enteral Feedings Can be intermittent or continuous Safety considerations Potential complications Removal of a nasogastric tube

Implementation  Administering Medication through a Feeding Tube Types of feeding tubes Checking for tube placement Checking the patency of tube Clearing the tubing of formula Flushing the port Measuring intake and output

Implementation  Providing Total Parenteral Nutrition (TPN) Intravenous infusion of a solution directly into a vein to meet the client’s daily nutritional requirements Used to treat malnourished clients or clients who have the potential for becoming malnourished and who are not candidates for enteral support.

Implementation  Components of Parenteral Nutrition Carbohydrates found primarily in form of dextrose Amino acids Lipids (fat emulsions)

Implementation  Complementary Therapy Nutrition is integrated as part of the therapeutic regimen of numerous types of complementary therapies. Diet and nutrition are used by many alternative modalities for the prevention and treatment of chronic diseases.

Evaluation  Current data is used to measure achievement of goals and outcomes.  The plan of care is modified to maximize the client’s response to therapy.