Nutrition Chapter 30

1. Nutrition � Chapter 30

2. Learning objectives Identify nutrition and fluid intake and output requirements across the lifespan Describe nutrition and fluid balance Identify types of nutrients Explain roles of nutrients in the body Identify food sources for nutrients

3. Learning objectives Explain types of therapeutic diets Explain the relationship of prescribed diet to nutritional/fluid balance Identify equipment for measuring nutrition and fluid intake and output Calculate nutritional/fluid intake and output

4. Learning objectives Define enteral feedings Explain the procedure for initiating enteral feedings and equipment used

5. Nutrition � You Are What You Eat Nutrition � the food you eat and how your body uses it Nutrients � chemical substances supplied by food that the body needs for growth, maintenance and repair Macronutrients � carbohydrates, fats, and proteins

6. Nutrition Nutritional status is determined: By what & how much the individual eats By his or her�s body ability to use nutrients By the state of the person as a result of the intake of nutrients

7. Factors Affecting Eating Culture Religion Socioeconomic Personal Preference Childhood Emotions Health Personal preference - ChildhoodPersonal preference - Childhood

8. Diet & Illness Some of our nation�s top leading causes of death have been associated with diet: Coronary heart disease Certain types of cancer Stroke Diabetes Atherosclerosis

9. Nutrition - Purpose 1. Provide energy for body processes & movement 2. Provide structural material for body tissue 3. Regulating body processes

10. Nutrients CHO, fats are well known as fuel foods � but protein is sometimes forgotten CHO � 4Kcal/gm FAT � 0 Kcal/gm Protein � 4 Kcal/gm

11. Simple vs Complex Carbohydrates Simple: Monosaccharides: Glucose, fructose, galactose Foods: grapes, oranges, dates, honey, corn syrup Type CHO that is absorbed from intestinal tractFoods: grapes, oranges, dates, honey, corn syrup Type CHO that is absorbed from intestinal tract

12. Simple CHO Disaccharides : Double sugar Sucrose, maltose, lactose W & B Sugar, molasses, honey, sweet potatoes, pineapples, carrots

13. Complex CHO Polysaccharides - Starches Fiber

14. Complex - Polysaccharides Starches � Large molecule of glucose Requires longer to digest Glucose available slower Ex: Cereal grains, corn, peas, potatoes, squash, legumes Starch increases with maturity Starch increases with maturity

15. Lipids -- Fat Classified According to three Criteria: Whether the fat is emulsified or nonemulsified Visible or invisible Simple or Compound

16. Visible vs. Invisible Fats Visible Fat: 40% Invisible Fat: Easily seen Hidden in foods on meat Egg yolk Oil Baked goods Butter Snacks Emulsified milk Cheese Olives Nuts Avocados

17. Fats Provide: Energy Insulation Cell membrane integrity Nerve impulse transmission Carries fat soluble vitamins (ADEK) Taste (satiety) 1. Energy � for now & stored fat for later energy 2. Insulation � Maintaining body temp & padding (protecting organs) 3. Cell membrane integrity 4. Nerve impulse transmission 5. Carries fat soluble vitamins (ADEK) Taste (satiety) � Adds texture & flavor to foods Fats: In Foods: Makes foods taste better Taste, smell, feel full Provide essential fatty acids Provide energy Carry fat soluble vitamins In Body: Insulation Padding Energy Cell membrane material 1. Energy � for now & stored fat for later energy 2. Insulation � Maintaining body temp & padding (protecting organs) 3. Cell membrane integrity 4. Nerve impulse transmission 5. Carries fat soluble vitamins (ADEK) Taste (satiety) � Adds texture & flavor to foods Fats: In Foods: Makes foods taste better Taste, smell, feel full Provide essential fatty acids Provide energy Carry fat soluble vitamins In Body: Insulation Padding Energy Cell membrane material

18. Fatty Acids Saturated: Unsaturated: One whose Has at least one structure is unfilled H+ spot completely Monounsaturated filled with all vs H+ it can hold Polyunsaturated Heavier, more The more unsat. dense,more solid the more liquid Requires higher at room temp. Temp. to melt

19. Monounsaturated Fatty Acid Usually of Plant origin Liquid at Room Temp Can Become saturated if a chemical change occurs Foods: Peanuts, Peanut oil, Olives & Olive oil, Almonds, Pecans, Canola oil

20. Polyunsaturated Fatty Acids Plant Origin Liquid at Room Temp. Foods: Vegetable Oils, Sunflower oils, some margarines, french dressing, walnuts

21. Trans-Fatty Acids Not currently mentioned on food labels Carry a risk similar to saturated fats Elevated blood cholesterol & thus raise the risk of heart disease & heart attack Are found in fast foods, chips, baked goods, & other commercially prepared foodsAre found in fast foods, chips, baked goods, & other commercially prepared foods

22. Blood Lipid Profile Triglycerides: <100 mg/dl desired Cholesterol: <200mg/dl 200-239 Borderline CVD. > 240 ^ risk Lipoproteins: HDL � High density � good 29-77 mg/dl Carry cholesterol away from cell LDL Low density � bad 62-185 mg/dl Carry cholesterol to cell

23. Cholesterol � Food Sources Egg Yolk Organ meats (especially liver & kidney) Cream Butter Ice Cream Cheese Cheese* ( The lighter in color the lower the amount of cholesterol) Cheese* ( The lighter in color the lower the amount of cholesterol)

24. What about Fat Substitutes? �O�lean�, Olestra O�lestra: is indigestible therefore the body has no way to take it apart Problems: causes digestive distress & nutrient losses i.e.: gas, diarrhea, cramping, strong �urge to go� Oil can leak thru feces & leak from the anus May interfere with absorption of fat soluble vitamins Remember � if it had or has a heart beat, it has cholesterol Remember � if it had or has a heart beat, it has cholesterol

25. Proteins � The Most Expensive Nutrient Building blocks are amino acids Structural part of every cell Found in scar tissue, hair growth, blood albumin, HemoglobinFound in scar tissue, hair growth, blood albumin, Hemoglobin

26. Four major functions of protein in the body Maintenance of Growth Regulation of Body Process Development of Immunity Energy

27. Amino Acids Essential: (9) Means they cannot be manufactured by body & must be obtained from food Nonessential: Can be synthesized by body Often derived from other amino acids (Essential) - 9 must be available simultaneously & in sufficient quantities for synthesis of body proteins (Essential) - 9 must be available simultaneously & in sufficient quantities for synthesis of body proteins

28. Complete vs Incomplete Protein Foods Complete: Have all 9 Essential Amino Acids Examples: Meat, Eggs, & Milk Incomplete: Lack some Amino Acids Some foods mixed together = a complete protein food Incomplete: Examples: Corn & peas Spaghetti Noodles & cheese Milk & cereal Rice with pork Noodles with tuna Incomplete: Examples: Corn & peas Spaghetti Noodles & cheese Milk & cereal Rice with pork Noodles with tuna

29. Dietary Fiber 20-35 g/day Soluble: Able to dissolve in H2O Beans, oatmeal, barley, broccoli, citrus fruits Regulate blood glucose level Helps with weight loss and lowers cholesterolHelps with weight loss and lowers cholesterol

30. Dietary Fiber Insoluble: Incapable of being dissolved Fruits and vegetable skins, nuts, popcorn Promote bowel regularity Decreases risk diverticular diseases, cancer Decreases risk diverticular diseases, cancer

31. Water � H20 Must be consumed often & in greater quantities Solvent in which chemical reactions occur Medium for transporting substances. Provides lubrication Contributes turgor to cells Regulates body temperature Medium for transporting substances. Ex: Blood, Lymph, Waste Provides lubrication. Ex: Synovial fluid & mucous Which food are high? Medium for transporting substances. Ex: Blood, Lymph, Waste Provides lubrication. Ex: Synovial fluid & mucous Which food are high?

32. Micronutrients - Vitamins Fat Soluble: A, D, E, K Stored in the body Stable in heat No nitrogen Require bile for absorption Soluble in fats Water Soluble: C, B Complex Soluble in water May be affected by cooking methods B Complex contains Nitrogen Very little stored therefore few toxic levels occur

33. Minerals Minerals, or elements: are inorganic substances Required in small amounts Cannot be synthesized in the body, must be obtained from food Some are important constituents of bones (Ca), others are required to activate specific enzymes involved in chemical reactions, to maintain acid-base balance (Mg, P, Na, Cl) & water balance (K, Cl) & muscle functions (Mg, K, Na, Ca). Approx. 3-6% of the body weight is made up of minerals (ash). Minerals should be supplied daily because they are excreted every day by the kidneys, bowel, & skin. Minerals are stored!

34. Minerals (con�t) Minerals are found in organic compounds or inorganic compounds & as free ions. Upon oxidation, minerals leave an ash, which can be acid or alkaline. Ca & P make up 80% of all mineral elements in the body. There are 2 categories: Macrominerals: These are minerals people require daily in amounts> 100 mg. Ex: Ca, P, Na, K, Mg, Cl Microminerals: are those that people require daily in amounts < 100 mg. Ex: Fe, Zn, I, F. Upon oxidation, minerals leave an ash, which can be acid or alkaline. Ca & P make up 80% of all mineral elements in the body. There are 2 categories: Macrominerals: These are minerals people require daily in amounts> 100 mg. Ex: Ca, P, Na, K, Mg, Cl Microminerals: are those that people require daily in amounts < 100 mg. Ex: Fe, Zn, I, F.

35. Consider the following when assessing Nutritional Status 1. Anthropometric measurements: Ht, Wt, Skin folds, Arm Circumference 2. Dietary History 3. Clinical signs of poor nutrition 4. Energy Level 5. Factors Affecting

36. Religious Considerations Jewish: Don�t mix meat & dairy products at the same meal Prohibited Foods: All products obtained from pigs: i.e.: pork, bacon, ham, animal shortening, marshmallows (gelatin)

37. Religious Considerations (con�t) Catholic: Abstain from eating meat & from eating between meals on Ash Wednesday & Good Friday Observe periods of fasting Seven-Day Adventist: Prohibited Foods: Pork products & shellfish Alcoholic beverages Church of Jesus Christ of the Latter-Day Saints (Morman): Alcoholic beverages Christian: Alcoholic beverages

38. Nursing Interventions to Encourage Nutrient Intake Assess situation: Foods, History, Health Issues, etc. Provide Foods they like Consult with Registered Dietician Environmental Changes Consider Medical Treatment: Meds around meals

39. Food Pyramid Guide MILK Products: 2-3 *Serving is 1 cup (8oz) FRUIT: 2-4 VEGETABLES: 3-5 BREADS & CEREALS: 6-11 MEAT/FISH: 2-3 * Serving is 2-3 oz.

40. Factors to Consider When Planning a Meal Include all of the food groups Use variety: Color, Texture, Flavor, Shape, Satiety, Sociologic & personal preference Time & Energy Appearance Economical fuel usage Food cost *Don�t overemphasis one food group*Don�t overemphasis one food group

41. Common Therapeutic Diets Regular Liquids: Full vs Clear Soft Low Residue Low Fat Low Carbohydrate Diabetic Low sodium High fiber Regular � No dietary restrictions Clear Liquid � Easily absorbed; short-term use after vomiting, diarrhea, or surgery Full liquid � Addition of dairy products and cream soups; provides more sustenance Mechanical soft � Used for dysphagia (supervision); difficulty chewing, or stomatitis Low Residue � for exacerbations of bowel disease (ulcerative colitis, diverticulitis) Diabetic � specific calorie count; for diabetic patients; recommended food exchanges by the American Diabetic Association; new diabetic clients require teaching and blood glucose monitoring to evaluation effect Low sodium � for congestive heart failure; renal, liver dysfunction, or hypertension High fiber � addition of fresh uncooked fruits, steamed veges, bran, oatmeal and dried fruits; for remissions of diverticulosis, IBS or ulcerative colitisRegular � No dietary restrictions Clear Liquid � Easily absorbed; short-term use after vomiting, diarrhea, or surgery Full liquid � Addition of dairy products and cream soups; provides more sustenance Mechanical soft � Used for dysphagia (supervision); difficulty chewing, or stomatitis Low Residue � for exacerbations of bowel disease (ulcerative colitis, diverticulitis) Diabetic � specific calorie count; for diabetic patients; recommended food exchanges by the American Diabetic Association; new diabetic clients require teaching and blood glucose monitoring to evaluation effect Low sodium � for congestive heart failure; renal, liver dysfunction, or hypertension High fiber � addition of fresh uncooked fruits, steamed veges, bran, oatmeal and dried fruits; for remissions of diverticulosis, IBS or ulcerative colitis

42. Calculating I & O:Do You Know Your Sources? Intake: Oral Fluids: H2O, Coke, Tea Ice chips Food (Liquid @ room temperature) Tube Feedings IV Fluids Irrigants Blood

43. Calculating I & O:Do You Know Your Sources? (con�t) Output: Urinary Vomitus Liquid Feces Tube Drainage Wound Drainage Fistula Drainage Rapid Respirations Diaphoresis

44. Parenteral Therapy Intake Equipment: IV Bag Drip Chamber Tubing Roller Clamp *Dial-a-Flow *Infusion Pump

45. Ways to control Volume of Fluid to Patients IV Pumps Solusets Dial-a-Flow Setting the correct rate on the pump Counting the number of drops in the drip chamber Assessing the patient frequently

46. Complications from IV Therapy Hematoma Phlebitis Hematoma: Collection of blood Infiltration: Seepage of fluid into the tissue rather than vein Hematoma: Collection of blood Infiltration: Seepage of fluid into the tissue rather than vein

47. IV Care Frequent assessment Antiseptic ointment at site Changing lines per hospital protocol (q 72 hours)

48. Insertion of a Nasogastric Tube for Suction or Feeding Have you collected ALL your supplies? What position do you need to place your patient? High Fowlers Which nostril should I use? How far do I insert the tube? Measure During insertion: What do I tell my patient. What should they be doing? What technique should I be doing? Do they stay in the same position the whole time?