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

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

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

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)

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

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

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

25. Proteins – The Most Expensive Nutrient • Building blocks are amino acids • Structural part of every cell

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

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

29. Dietary Fiber 20-35 g/day • Soluble: • Able to dissolve in H2O • Beans, oatmeal, barley, broccoli, citrus fruits • Regulate blood glucose level

30. Dietary Fiber • Insoluble: • Incapable of being dissolved • Fruits and vegetable skins, nuts, popcorn • Promote bowel regularity

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

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.

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

41. Common Therapeutic Diets • Regular • Liquids: Full vs Clear • Soft • Low Residue • Low Fat • Low Carbohydrate • Diabetic • Low sodium • High fiber

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

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?

49. Bolus vs Continuous enteral feeding

50. Measurement for NG tube