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Nutrition

Nutrition. Chapter 44. Elements of Energy and Nutrition. Basal metabolic rate (BMR) Resting energy expenditure (REE) Nutrient density Nutrients: carbohydrates, proteins, fats, water, vitamins, minerals. Carbohydrates. Produce 4 kcal/g Main source of energy

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Nutrition

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  1. Nutrition Chapter 44 NRS105_Collings

  2. Elements of Energy and Nutrition • Basal metabolic rate (BMR) • Resting energy expenditure (REE) • Nutrient density • Nutrients: carbohydrates, proteins, fats, water, vitamins, minerals NRS105_Collings

  3. Carbohydrates • Produce 4 kcal/g • Main source of energy • Saccharides: simple and complex carbohydrates, fiber NRS105_Collings

  4. Proteins • Produce 4 kcal/g • Essential for growth, maintenance, and repair of body tissue • Amino acids: essential and nonessential • Complete and complementary proteins • Nitrogen balance NRS105_Collings

  5. Fats (Lipids) • Produce 9 kcal/g • Triglycerides and fatty acids • Saturated or unsaturated: monounsaturated or polyunsaturated fatty acids • Essential or nonessential fatty acids NRS105_Collings

  6. Water • Comprises 60% to 70% of body weight • Cell function depends on a fluid environment NRS105_Collings

  7. Vitamins • Essential to normal metabolism • Fat-soluble: A, D, E, K • Water-soluble: C and B complex NRS105_Collings

  8. Minerals • Inorganic elements essential as catalysts in biochemical reactions • Macrominerals • Microminerals or trace elements NRS105_Collings

  9. Digestive System • Anatomy and physiology • Digestion • Absorption • Metabolism and storage of nutrients • Elimination NRS105_Collings

  10. Dietary Guidelines • Dietary referenced intakes (DRI’s) • Recommended range of intake • Food guidelines: food guide pyramid • Daily values • Healthy People 2010 focus area • Specific diets: diabetic, gluten-free, culturally specific NRS105_Collings

  11. Nutritional Needs throughout Growth and Development • Infants through school-age • Breast-feeding • Formulas • Solid foods • Food habits • Adolescents • Eating disorders • Activities NRS105_Collings

  12. Nutritional Needs throughout Growth and Development (cont'd) • Young and middle adults • Pregnancy • Lactation • Older adults • Less efficient systems • Constipation, decreased absorption of nutrients • Altered [diminished] sense of taste • Chewing/swallowing problems NRS105_Collings

  13. Alternative Food Patterns • Cultural and religious practices • Vegetarian diets NRS105_Collings

  14. Assessment: Diet History • Dietary intake and pattern • Symptoms • Allergies • Taste • Chewing and swallowing • Appetite • Elimination • Medications NRS105_Collings

  15. Assessment • Anthropometry [Ht, Wt, measurement, BSA] • Body mass index (BMI) • Ideal body weight (IBW) • Laboratory tests • Clinical observations • Client expectations NRS105_Collings

  16. Nursing Diagnoses • Risk for aspiration • Alteration in fluid/electrolyte balance • Imbalanced nutrition: less than/more than body requirements • Self-care deficit: Feeding • Knowledge deficit NRS105_Collings

  17. Planning • Goals and outcomes • Client’s daily nutritional intake will meet his needs AEB… • Client will lose ½ pound per week until… • Pt will choose foods that meet his nutritional needs /fit within dietary guidelines • Education/ pt teaching • Continuity of care – written plan NRS105_Collings

  18. Implementation: Health Promotion • Client education • Meal planning • Food storage and preparation safety NRS105_Collings

  19. Implementation: Acute Care • Advancing diets • Promoting appetite • Assisting clients with feeding • Enteral feeding • Can’t ingest, can digest/eliminate • Parenteral nutrition • Can’t ingest/digest/eliminate [any or all] NRS105_Collings

  20. Enteral Feeding • Nasogastric, jejunal, gastric tubes • Insertion and verification of placement • X-ray best; 2 other methods if no X-ray • Types and preparation of formulas • Complete or elemental, cal/ml ordered • Complications • Aspiration, occlusion, imbalances NRS105_Collings

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  22. Parenteral Nutrition • Initiation and management of insertion site [surgical asepsis] • PIV, PICC • Types of solutions • Dextrose, TPN, Lipids • Rate of infusion – use pump • Prevention of complications • Emboli, sepsis, occlusion NRS105_Collings

  23. Implementation: Restorative Care • Medical nutrition therapy for specific illnesses, conditions, or injuries • GI diseases [avoid irritants, eat often] • Diabetes [carbs, limit fat, individualize] • Cardiovascular diseases [limit salt, fat] • Cancer [hi nutrient, flavor, digestibility] • HIV [max nutrition, calories] NRS105_Collings

  24. Evaluation • Short term: did pt. choose foods…. • ..eat breakfast… go to DR • Long term: did pt. gain/lose wt? • Revise goals as needed • Teach pt/caregiver & involve to promote independence and health • Pass info to next setting [LTC] NRS105_Collings

  25. Questions? NRS105_Collings

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