Fundamentals of Nursing

Nutrition

Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of NutritionNutrition is the process by which the body metabolizes and utilizes the nutrients from food.

Nutrients are digested by the GI system and then absorbed by the blood or lymphatic system, and transported to the bodys cells.

Physiology of NutritionDigestion is the process by which ingested foods are broken down in the GI tract to smaller segments in preparation for absorption.

The end products of digestion are monosaccharides (simple sugars), amino acids, glycerol, fatty acid chains, vitamins, minerals, and water.

Physiology of NutritionAbsorption : is the process by which the end products of digestion pass through the epithelial membranes in the small and large intestines into the blood or lymph systems.

Physiology of NutritionMetabolism is the aggregate of all chemical reactions and processes in every body cell, such as growth, generation of energy, elimination of wastes, and other bodily functions as they relate to the distribution of nutrients in the blood after digestion.

Metabolic rate refers to the rate of heat liberation during chemical reactions.

MetabolismEnergyA calorie is the unit of measurement used to express the quantity of energy released during metabolism.Energy is expressed in terms of kilocalories.Basal metabolic rate (BMR) represents the energy needed to maintain essential physiological functions.

MetabolismExcretionDigestive and metabolic waste products are excreted through the intestines and rectum.Other excretory organs are the kidneys, sweat glands, skin, and lungs.

NutrientsWaterVitaminsMineralsCarbohydratesProteinsLipids

NutrientsWaterAccounts for 60% to 70% of an adults total body weight and 77% of an infants weight.Water and electrolytes are substances that must be acquired from the diet.Body water requirements are met through consumption of liquids and foods and the oxidation of food.

NutrientsVitaminsOrganic compounds that aid in the regulation of cellular metabolism and assist in the biochemical processes that release energy from digested foodVitamins are classified as fat-soluble or water-soluble.

NutrientsCarbohydratesOrganic compounds composed of carbon, hydrogen, and oxygenPrimary source of energy for the brain and the preferred fuel for the body

NutrientsCarbohydratesMonosaccharides (simple sugars) include glucose, galactose, and fructose.Disaccharides (double sugars) include sucrose, lactose, and maltose.Polysaccharides (complex sugars) include glycogen, cellulose (fiber), and starch.

NutrientsProteinsOrganic compounds that contain carbon, hydrogen, oxygen, and nitrogen atoms combine to form proteins.

Essential for almost every bodily function.

NutrientsThe end products of protein digestion are amino acids which categorized to:

Nonessential amino acids: can be synthesized in the body.Essential amino acids must be ingested in the diet because they cannot be synthesized in the body.

NutrientsLipids (fats) Organic compounds are the only essential nutrients that cannot mix with water and therefore, must be emulsified by molecules to be absorbed.

Fats are lipids that are solid at room temp.Oils are lipids that are liquid at room temp.

NutrientsMost Important LipidsTriglycerides are composed of three fatty acid cells attached to a glycerol molecule.Phospholipids are composed of one or more fatty acid molecules and one phosphoric acid radical; they usually contain a nitrogenous base.Cholesterol is produced by the body and is considered a fat; it is also found in whole milk and egg yolk.

Promoting Proper NutritionThe Food Guide Pyramid outlines six groups of food and the number of servings based on dietary guidelines and the basic four food groups.

Promoting Proper NutritionSocietal ConcernsOne-third of the U.S. population is considered overweight.Obesity is becoming an epidemic.Undernutrition is a specific problem for the elderly and for people with eating disorders.

Weight ManagementOverweight is an energy imbalance in which more food is consumed than needed.

An underweight person expends more calories than are consumed.

Factors Affecting NutritionAgeLifestyleEthnicity, CultureReligious PracticesEconomicsGenderMedication

AssessmentNutritional History24-hour recallDifficulty eatingChanges in appetiteDiet history & preferencesChanges in weightGeneral health & medical history

AssessmentPhysical ExaminationIntake and Output (I & O)Anthropometric Measurements - Skinfold measurements: used to determine fat storesMid-upper-arm circumference: measures fat, muscle & boneAbdominal-girth measurement

AssessmentMeasuring the mid-upper-arm circumference

Nursing DiagnosesImbalanced Nutrition: Less Than Body RequirementsImbalanced Nutrition: More Than Body Requirements or Risk for More Than Body Requirements

Other Nursing DiagnosesActivity IntoleranceAcute PainIneffective Health MaintenanceConstipationImpaired Swallowing

ImplementationMonitoring Weight and IntakeDiet TherapyNothing by Mouth (NPO)Clear-Liquid diet Full-Liquid dietSoft dietDiet as tolerated

ImplementationDiet TherapyLow-residue High-fiber Liberal bland Fat-controlled Sodium-restricted Lactose intolerance

ImplementationAssistance with FeedingProviding Nutrition SupportNutrition Support Teams

ImplementationProviding Enteral Nutrition: is an alternative method to give adequate nutrition used when the client is unable to ingest foods or the GI tract is impaired.

Feeding tubes (e.g nasogastric tube)Insertion of enteral feeding tubesEnteral formulas

Enteral Feeding Routes

ImplementationAdministration of Enteral FeedingsCan be intermittent or continuousSafety considerationsPotential complicationsRemoval of a nasogastric tube

ImplementationAdministering Medication through a Feeding TubeTypes of feeding tubesChecking for tube placementChecking the patency of tubeClearing the tubing of formulaFlushing the portMeasuring intake and output

ImplementationProviding Total Parenteral Nutrition (TPN)Intravenous infusion of a solution directly into a vein to meet the clients daily nutritional requirementsUsed to treat malnourished clients or clients who have the potential for becoming malnourished and who are not candidates for enteral support.

ImplementationComponents of Parenteral NutritionCarbohydrates found primarily in form of dextroseAmino acidsLipids (fat emulsions)

ImplementationComplementary TherapyNutrition is integrated as part of the therapeutic regimen of numerous types of complementary therapies.Diet and nutrition are used by many alternative modalities for the prevention and treatment of chronic diseases.

EvaluationCurrent data is used to measure achievement of goals and outcomes.

The plan of care is modified to maximize the clients response to therapy.

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