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Good Nutrition

Good Nutrition. Nutrition. Developed by Ginger Mize RN, MN Modified by Jill K. Ray NUR302. Nutrition. Basic Human Need Changes throughout the life cycle Changes along the wellness-illnes continuum. Eating. Necessary to survive Source of pleasure Pastime Social event

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Good Nutrition

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  1. Good Nutrition

  2. Nutrition Developed by Ginger Mize RN, MN Modified by Jill K. Ray NUR302

  3. Nutrition • Basic Human Need • Changes throughout the life cycle • Changes along the wellness-illnes continuum.

  4. Eating • Necessary to survive • Source of pleasure • Pastime • Social event Different meanings to different people….

  5. Nutrients • Specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness (p. 1413).

  6. Essential Nutrients • Not synthesized in the body • Made in insufficient amts • Must be provided in the diet

  7. Six Classes of Nutrients • 3 supply energy • Carbohydrates • Proteins • Lipids • 3 are needed to regulate body processes • Vitamins • Minerals • Water

  8. Energy Balance • Energy is derived from foods consumed. • Measured in form of kilocalories, abbreviate as calories.

  9. Energy Balance • What are the body’s sources of energy? • Carbohydrates, protein, and fat • If a person’s daily energy intake is equal to total daily energy expenditure the person’s wt will remain stable.

  10. Carbohydrates • Main source of energy • Glucose • Brain • Skeletal muscles

  11. Carbohydrates • Sugars & Starches • Easy to produce and store • In some countries where grains are dietary stable, CHO may contribute as much as 90% to daily calorie consumption • Some sources correlate to income. Speculating that as income increases, CHO intake decrease and protein intake increases.

  12. Carbohydrates • More easily and quickly digested than protein and fat. 90% is digested. This percentage decreases as ____intake increases. • fiber

  13. Fats (Lipids) • Triglycerides and fatty acids • Saturated or Unsaturated fatty acids

  14. Proteins • Synthesis of body tissue • Collagen, hormones, enzymes, immune cells • Amino acids: essential and nonessential Nitrogen balance

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

  16. Sources, functions, & significance of Carbohydrates, proteins, & fats • P.1419 Table 42-3 • Note functions that this table lists for the nutrient. • Which nutrient should a patient increase in his diet after surgery?

  17. Sources, functions, & significance of Carbohydrates, proteins, & fats • Note food sources of the nutrient. • Which of the following should this same patient eat 1st on his lunch tray: orange, chicken tenders, Lima beans, whole wheat roll.

  18. Vitamins • Water soluble (Vitamin C and the B-complex vitamins) • Not generally stored in body • Need daily intake to prevent symptoms of deficiency

  19. Vitamins • Fat soluble (ADEK) • Must be attached to a protein to be transported through the blood • Secondary deficiencies can occur anytime fat digestion or absorption is altered (i.e. malabsorption syndromes, mega diets…)

  20. Minerals • Some provide structure within the body • Some help regulate body processes • Macro minerals (those needed by the body in amts greater than 100mg/day) • Calcium • Phosphorus • Sulfur • Sodium • Chloride • Potassium • magnesium

  21. Water • Major body constituent present in every body cell • More vital to life than food.

  22. Water • Provides the fluid medium necessary for all chemical reactions, • participates in many reactions, • is not stored in the body. • Acts as a solvent, aiding in digestion • Assists in the regulation of body temperature • Acts as a lubricant for mucous membranes

  23. Water • Accounts for 50-60% of adult total wt • 2/3 is contained in the body’s cells (intracellular fluid – ICF) • 1/3 all other body fluids (extracellular fluid – ECF) this includes plasma and interstitial fluid.

  24. Basal Metabolism • Energy required to carry on the involuntary activities of the body at rest; • the energy needed to sustain the metabolic activities of cells and tissues and to maintain circulatory, respiratory, gastrointestinal, and renal processes (p. 1415).

  25. Who has the highest Basal Metobolism Rate? • Men • Women • Why • Because of higher muscle mass. Men are about 1cal/kg and women .9 cal/kg.

  26. What other factors increase BMR? • Growth • Fever • Infections • Emotional tension, • Extremes in temperature • Hormone levels (thyroid hormone, epinephrine)

  27. What decreases BMR? • Aging • Prolonged fasting • sleep

  28. Ideal Body Weight • Body Mass Index • Waist circumference • Formula: • BMI = wt in kg/(ht in meters) times (height in meters) • BMI = (wt in lbs/(ht in inches) times (height in inches)) times 703

  29. General Guidelines • BMI below 18.5 is underweight • BMI of 25 – 29.9 is overweight • BMI of 30 or greater obesity • BMI of 40 or greater extreme obesity

  30. Calculate BMI for a patient who weighs 100 pounds and is 5 feet tall. • BMI = (wt in lbs/(ht in inches) times (height in inches)) times 703 • BMI = (100/60 times 60) times 703 • BMI = (100/3600) times 703 • BMI = .027 times 703 = 19.52

  31. 19.52 • BMI below 18.5 is underweight • BMI of 25 – 29.9 is overweight • BMI of 30 or greater obesity • BMI of 40 or greater extreme obesity • How would you characterize this pt’s BMI?

  32. Weight loss • Usual wt – present wt /usual wt times 100 • Significant if: • 1%-2% in 1 week • 5% in 1 month • 7.5% in 3 months • 10% in 6 months

  33. Factors Affecting Nutrition • Food intake • Decreased food intake can be related to • disease, • psychosocial causes, • impaired ability to smell and taste, • drug therapy, • medical treatments, • difficulty chewing and swallowing, chronic GI problems, • certain chronic illnesses (ca) • Inadequate food budgets • Nausea • pain

  34. Nursing Indications…. • If a pt is NPO…what is our responsibility as a healthcare provider to ensure that he maintains an adequate nutritional status? • Consider: • Nutrients (which ones?) • Water balance • Can we feed a pt that a MD has made NPO?

  35. Factors food intake: • Increased food intake: • Excess wt increases the risk • for numerous medical problems • assoc with surgery • For complications during pregnancy, labor, and delivery • Incr morbidity and mortality • Reasons for overeating….

  36. Physiologic and physical factors that influence nutrient requirements • Developmental considerations: • Throughout the life cycle nutrient needs change in relation to growth, development, activity, and age-related changes in metabolism and body composition. • Review each area in this section of the required reading

  37. Gender • Men have more muscle mass and therefore have higher caloric and protein requirements than women.

  38. State of Health • Trauma (major surgery, burns, crush injuries) • Dramatically alters the body’s use of nutrients. • Nutrient requirements increase dramatically to allow the body to preserve or replenish body nutrient stores and to promote healing and recovery. • Mental health problems can cause to forget to eat, or lack motivation to eat.

  39. Alcohol Abuse • Affects the intestinal mucosa. Interferes with normal nutrient absorption, so requirements for the nutrients increase as the efficiency of absorption decreases. • Need for B vitamin increases because they are used to absorbed alcohol.

  40. Medication • Especially drugs that • alter the pH of the GI tract • Increase GI Motility, • damage intestinal mucosa, • bind with nutrients

  41. Sociocultural and Psychosocial Factors Religion: • Mormons: no coffee, tea, alcohol, encouraged to limit meat consumption • Hindus do not eat beef, many Hindus are vegetarians • Kosher dietary laws: special food preparation techniques and prohibit the intake of pork and shellfish

  42. Culture • See box 42-4. p. 1434.

  43. The Nsg Process • During illness, good nutritional status can reduce the risk for complications and speed recovery • Poor nutritional status can increase the risk for illness or death and prolong the healing process.

  44. Assessment • Health History • Dietary History • Physical Assessment • Anthropometrics • Laboratory Tests • DETERMINE reviewed in the text on p. 1435

  45. 24 Hour Food Recall • Upon waking: large glass of water • OTWTW: 1 cup of coffee w/sugar & cream, large bagel w/cream cheese • During morning: 2 coffees w/2 Danishes • Lunch: Hamburger w/fries-”supersized”, lg. sweet tea • Afternoon: pack of M&M’s • Dinner: Steak, baked potato, green beans, salad, apple pie a la mode, lg. sweet tea • After dinner: 2 beers

  46. Dietary Guidelines • Dietary referenced intakes (DRIs) • Food Guide Pyramid • Daily values • Healthy People 2010

  47. Food Pyramid

  48. 24 Hour-Food-Intake Assessment • http://www.mypyramid.gov/mypyramid/results.html?age=54&gender=male&activity=sed

  49. Assessment of 24 Hr. Food Recall • Grains: potato(7) bagel(2) danishes(4) bun(2),fries(6) [ >19 oz.] 5oz. • Veggies: lettuce, tom, pickles, green beans, salad [~ 2 cups] 2 cups • Fruits: 0 1½ cups • Milk: cream??!!! [oils] 3 cups/5 tsp oil • Meat/beans: Hb(4-6), steak (8-12) [~12-18] 5 oz.

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