1. Chapter 47
Nutrition
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2. Objectives
Differentiate between information found in the dietary reference intake tables and the Recommended Dietary Allowances table
Identify the function of macronutrients in the body
Compare and contrast the Estimated Energy Requirement for a healthy male and female of similar height, weight, and level of activity
Differentiate between fat-soluble and water-soluble vitamins
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3. Objectives (cont’d) Research good dietary sources of fiber
Differentiate between fat-soluble and water-soluble vitamins
List five functions of minerals in the body
Identify exercise guidelines currently recommended for people with different daily patterns of physical activity (sedentary, low active, active, and very active)
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4. Principles of Nutrition
Nutritional requirements depend on:
Age
Gender
Level of activity
Pregnancy/lactation
Food guide pyramids
Food Guide Pyramid (1991)
Healthy Eating Pyramid
Oldways –
MyPyramid –
Essential nutritional assessment: history of nutritional deficit and patient dietary practices, laboratory tests, physical changes.
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5. Dietary Reference Intakes
USDA retired the old Food Guide Pyramid and replaced it with MyPyramid, a new symbol, and interactive website (
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6. Dietary Reference Intakes (cont’d)
Set of four reference values
Estimated Average Requirement (EAR)
Recommended Dietary Allowances (RDAs)
Adequate Intake (AI)
Tolerable Upper Intake Level (UL)
List average daily dietary intake levels sufficient to meet nutrient requirements of healthy individuals in a group
RDA does not meet the nutritional needs of ill patients. It is based on the EAR plus 2 standard deviations.
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7. Estimated Energy Requirement
Males versus females for the same activity level, height, weight
Use the formula (Table 47-4)
(Using low active for physical activity level)
19-year-old male, 180 lb/82 kg, 5'11”/177 cm (0.18 m) = 2026
19-year-old female, 125 lb/56 kg, 5'4”/ 160 cm (0.16 m) = 926
EER is the average dietary energy intake that is predicted to maintain energy.
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8. Macronutrients
Macronutrients – carbohydrates, fiber, fats, proteins needed to provide energy
Kilocalories (kcal): measure of energy
Daily caloric needs
45% to 65% of calories should come from carbohydrates
20% to 35% of calories should come from fats
10% to 35% of calories should come from proteins
Reasons for increased metabolic needs: increased activity, surgery, trauma, burns, infection.
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9. Carbohydrates and Fiber
Carbohydrates – sugars; major source of energy
Simple = monosaccharides and disaccharides
Complex = polysaccharides
Fiber
Dietary fiber – derived from plant sources
Functional fiber – undigestible carbohydrates
Sources of fiber – cereal bran and vegetables
Total fiber = dietary fiber + functional fiber
Examples of monosaccharides: glucose, fructose, and galactose.
Common table sugar is known as sucrose.
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10. Fats and Proteins Fats: lipids; body’s major form of stored energy
Monounsaturated – decrease LDL; increase HDL
Polyunsaturated – decrease LDL; increase HDL
Saturated – increase LDL; increase HDL
Trans – increase LDL; decrease HDL
Proteins: molecules composed of amino acids
Essential – from external sources
Nonessential – can be synthesized
Olive oil is a monounsaturated fat. Sources of polyunsaturated fats include nuts, seeds, and soybeans.
Saturated fats come from red meats, butter, and high-fat dairy products.
Some sources of trans fats are commercially fried foods, stick margarine, processed ready-to-eat foods, snack foods.
Consumption of saturated fats and trans fats leads to heart disease.
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11. Vitamins and Minerals Vitamins (total of 13)
Water soluble (9) – vitamins C, B1, B2, B3, B5, B6, B12, folic acid, biotin
Fat soluble (4) – vitamins A, D, E, K
Minerals (e.g., calcium, iodine, iron)
Functions
Acid-base and water balance
Cell membranes’ permeability and osmotic pressure
Nerve conduction
Muscle contractility
Metabolism of nutrients in food
Vitamin deficiencies – beriberi is a thiamine (B1) deficiency; scurvy is a vitamin C deficiency.
Minerals are inorganic chemicals in nature, components of enzymes, hormones, and bone and tooth structure.
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12. Exercise Guidelines
Lifestyle and dietary choices combine to lead to obesity
Recommended to maintain BMI range 18-25
Physical activity levels recommended
Moderate – 30 minutes daily
Moderate intensity – 60 to 90 minutes daily
High intensity – 20 to 30 minutes four to seven times weekly
Obesity leads to type 2 diabetes, cardiovascular disease, and premature death.
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13. Chapter 47
Lesson 47.2
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14. Objectives
Describe physical changes associated with a malnourished state
Describe nutritional assessments essential before the administration of tube feedings and parenteral nutrition
Cite common laboratory and diagnostic tests used to monitor a patient’s nutritional status
Discuss nursing assessments and interventions required during the administration of enteral nutrition
Discuss home care needs of a patient being discharged on any form of enteral or parenteral nutrition
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15. Malnutrition Forms Physical changes Nutrition supplementation
Marasmus – lack of calories and protein
Kwashiorkor – protein deficiency
Mixed kwashiorkor-marasmus – inadequate protein and wasting of fat stores and muscle
Physical changes
Muscle atrophy; dry, dull hair; dry, flaky skin; fat depletion in waist, arms, legs; edema
Nutrition supplementation
Enteral – administered orally or through feeding tube
Parenteral – administered intravenously
Patients with chronic disease are more likely to be malnourished and have nutrition deficits.
Marasmus is the most common form of malnutrition in hospitalized patients who suffer from chronic disease.
Patients with kwashiorkor are difficult to recognize because they appear well nourished.
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16. Common Laboratory Tests
Prescribed before initiating parenteral or enteral feeding
Blood tests: serum prealbumin; albumin; urea nitrogen; creatinine; electrolytes; hemoglobin; hematocrit; lipids; liver function studies; glucose; total lymphocyte count; ferritin; transferrin
Urine tests: specific gravity; ketones
Slide 16
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17. Enteral Feeding Actions Uses Common adverse effects
Provide nutrients through GI tract by nasogastric, nasoduodenal, or nasojejunal tube, feeding gastrostomy or jejunostomy
Uses
When oral consumption is either inadequate or contraindicated (e.g., neck surgery, esophageal obstruction, stroke, etc.)
Common adverse effects
Hyperglycemia
Serious adverse effects
Pulmonary complications, diarrhea, constipation, hypersensitivity
Record accurate intake and output measurements.
Ensure that sterile administration techniques are followed.
Check for fluid overload.
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18. Parenteral Feeding Actions Uses Common adverse effects
Provide balanced combination of carbohydrates, amino acids, essential fats
Uses
Inability to take nutrition enterally for 7 days; intractable vomiting and diarrhea; malabsorption syndromes; bowel surgery; coma; massive wound or burn healing
Common adverse effects
Hyperglycemia
Serious adverse effects
Hypoglycemia, fluid and electrolyte imbalance
Peripheral parenteral nutrition (PPN) is used for patients requiring nutritional support for a limited time of 3 to 4 weeks.
Total parenteral nutrition (TPN) can be given long or short term, depending on indication.
Be aware that hepatotoxicity or allergy to the formula may develop.
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19. Monitoring Parenteral Feeding
Double-check solutions for expiration date and bottle number
Check tubing, connections, flow rates to avoid air embolism or contamination
Assess venous access site for redness, swelling, drainage
Observe for fluid and electrolyte imbalances, hyperglycemia
Discard TPN solution that remains after 24 hours.
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20. Home Care Needs for Parenteral and Enteral Nutrition
Monitor blood glucose regularly
Assess for refeeding syndrome
Monitor weight, vital signs, required laboratory tests
Have next container of solution prepared
Do not “push” TPN if it gets behind schedule
TPN must be tapered and never completely disconnected.
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