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building up of more complicated biochemical substances
- decrease of hgb in blood
- can be caused by loss of blood, decrease RBC production or increase in RBC destruction
lack of or loss of appetite
measurement system of size and body makeup
a natural, indistinctive desire such as for food
the act of taking a breath or inhaling
Basal Metabolic Rate
- the energy requirement of a person at rest
- amt of energy needed to maintain life-sustaining activities for a specific amt of time
- ie; breathing, circulation, HR and temp
chewed food that is ready to be swallowed
- general ill health and malnutrition
breaking down of biochemical substances into simpler substances
cracks on the lips/ sides of the mouth due to lack of riboflavin
nutrition given via the GI tract
Essential Amino Acids
Amino acids the the body cannot make and must be provided by the diet
Composed of chains of C and H atoms with an acid group at one end of the chain and a methyl group at the other
Monosaturated Fatty Acid has
one double bond
Polysaturated Fatty Acid has
2 or more double C bonds
Saturated Fatty Acid
each C in the chain has two H atoms attached
- structural carbohydrayes usually found in plants which cannot be digested by humans
- we do not have the enzyme capability of breaking them down
- comes mainly from plant foods, bran, barley or lentils
- factor in disease prevention and treatment of diarrhea
- those with a high fiber intake are less likely to suffer from obesity, constipation and colon cancer
surgical creation of an artificial opening into the stomach through the abdominal wall
inflammation of the tongue
catabolism of amino acids and gylcerol into glucose for energy
Anabolism of glucose into glycogen for storage
Catabolism of glycogen into glucose, CO2 and H2O
making of fatty acids
- any disorder of nutrition
- ie, unbalanced, insufficient or excessive diet
inorganic elements essential to the body as catalysts in biomechanical reactions
I & O of N is =
the proportion of essential nutrients to the number of calories in food
nutrient support when nutrients are provided thru IV
3 Fatty acids attached to a glycerol
- organic substances that are essential to normal metabolism
- body is unable to synthesis vitamins in the required amts and thus depends on dietary intake
- they assist other nutrients and are needed in digestion, absorption, metabolism and excretion
- sources are fruits and vegetables
- Vitamin A deficiency can cause night blindness, dry skin; sources include beta-carotene and leafy veggies
- Vitamin C deficiency can cause scurvy or bleeding in the mouth; sources include fruits and veggies
- Vitamin D deficiency can cause ricketts or soft bones; sources include milk, meat and the sun
- Vitamin K is needed for clotting, deficiency can be seen in bleeding bc it counteracts anti-coagulant drugs; sources include bananas
- A,D,E &K
- can be stored in the body
- C & B Complex
- Cannot be stored in the body and must be provided through daily intake
The 6 Basic Nutrients:
- source- obtained mainly from plant food
- function- main source of energy; main source of fuel for the brain, skeletal muscles, RBC & WBC production
- stored in the liver and muscles as glycogen
- excess is stored as fat
- source- grains, meat and beans
- function- essential for synthesis of body tissue, maintenance and repair; RNA, DNA, hormones and enzymes are composed of
- contains all the amino acids that we need
- source- animal and vegetable fats
- function- source of energy storage; important metabolic processes and vitamin absorption.
- most dense form of energy and a major component of cell structure, hormones & padding for the body
- Fx- critical component of the body bc cell fx depends on a fluid environment
- composes 60-70% of the body weight
- we need 2.5 to 3 L daily
- source- food
- fx- essential as a catalyst in biochemical reactions; minerals are needed for the structures of bones and teeth
- affect the shift of body fluids and are necessary for the proper fx of the CNS and muscles
- Major Minerals are ones in which we need more than 100mg daily
- Trace Minerals are ones in which we need less than 100mg daily
Nitrogen Balance and Nutrition
- Nitrogen balance is achieved when nitrogen I=O.
- When I >O, you are in a + N balance; this is required for growth, pregnancy, maintenance of lean muscle mass, vital organs and wound healing.
- When I<O you are in a - N balance; this results in destruction of the body tissues or decrease in N containing fluids.
- N in the body is used for building repairing and replacement of body tissue.
Vitamin: Deficiency and Excess
- D= can cause cellular and organ dysfunction that may lead to slower recovery from injury or illness
- E= of any vitamin is going to act as a free chemical and may be toxic to the body
Describe the key points of the 2005 Dietary Guidelines for Americans, including the USDA Food Guide and My Pyramid.
- The FDA food guide pyramid provides a guide to daily food choices
- Eating a variety of foods and getting the appropriate number of calories and g of fat for a healthy weight are recommended
- The current pyramid recommends:
- 1. 6-11 servings of bread/cereal/rice/pasta
- 2. 3-5 servings of vegetables
- 3. 2-3 servings of milk/yogurt/cheese
- 4. 2-3 servings of meat/poultry/fish/beans/nuts/eggs
- 5. for fats/oils/sweets it is recommended that they are used sparingly, limit to 30% of calories
- It is recommended that you:
- 1. eat a variety of food
- 2. maintain a healthy weight by balancing caloric intake with activity
- 3. choose a diet low in fat, saturated fat and cholesterol
- 4. choose a diet with plenty of fruits, vegetables and grains
- 5. use sugar, salt and Etoh in moderation
Outline the information needed to obtain a dietary hx.
The RN obtains a specific diet hx to assess the pt's actual or potential needs.
- Information needed includes:
- 1. pt's habitual intake of foods and liquids
- 2. preferences
- 3. allergies
- 4. financial ability to obtain food
- 5. pt's illness/activity level to determine energy needs and then compares this with food intake
Describe the components of a nutritional status assessment, including albumin, pre-albumin, glucose, total protein lipid profile and lab data, identifying clinical signs of inadequate nutrition, height, weight and BMI.
- Components of nutritional assessment:
- 1. health status
- 2. age
- 3. cultural bkgd
- 4. socioeconomic status
- 5. personal preferences
- 6. psychological factors
- 7. use of Etoh or illegal drugs
- 8. vitamin, mineral or herbal remedies
- 9. rx or otc remedies
Albumin indicates body protein status, does not detect early changes in nutritional status and has a t1/2 of 21 days. nl= >3.5g/dl
Pre-albumin also indicates protein status but is preferred in short term or acute conditions bc it has a t1/2 of 2 days. nl= 10-40g/dl
- Glucose indicates the amt of sugar in the blood and is an indicator of diabetes. Fasting glucose should be b/t 65-99mg/dl. Prediabeties or Impaired Fasting Glucose should be b/t 100-125mg/dl
- Lipid profile indicates food vs blood cholesterol. 3 types of serum cholesterol with LDL = <130?, VLDL = 200-400 and HDL = >35. nl cholesterol is 160-200 mg/dl?
Additional lab tests include TLC (total lymphocyte count), 24hr urinary urea nitrogen levels, transferrin and TIBC (total iron binding capacity)
- Clinical signs of inadequate nutrition include:
- 1. General appearance, listlessness, emaciated
- 2. Sagging posture
- 3. Flaccid or poor muscle tone
- 4. inattention, irritability or confusion
- 5. Anorexia, diarrhea or constipation
- 6. Rapid HR, elevated BP, Dysrrythemias
- 7. Dull, brittle hair or rough, dry skin
- 8. Dry, swollen, cracked lips
BMI: shows weight corrected for height. It is determined by dividing pt's weight in Kg by their height in m2
. Healthy= 18.5-24.9, Overweight= 25.0-29.9, Obese= >30
IBW: Ideal body weight uses the rules of 5's & 6's. Women's IBW = 100lbs + 5lbs for each 1" over 60". Men's IBW = 106lbs + 6lbs for each 1" over 60".
Discuss the influence religion, values, culture, lifestyle, economics and health status have on a person's diet and eating habits.
Religion: some religions restrict meat on Holy days or all together, many religions also have a time of fasting for a religious reason.
Values: Pt's values affect what they are willing to eat or not eat based on what they feel is right or wrong.
Culture: Lactose Intolerance is high in certain ethnic groups thus farcing them to find those nutrients elsewhere, Various cultures from differing geographical regions have different diets based on what is available to them
Lifestyle: Vegans and vegetarians need to find the nutrition they would be getting from meats elsewhere, like wise pt's who have addictions to drugs or Etoh might choose to spend $ on those rather than food.
Economics: Healthy foods tend to be more expensive, therefore pt's who struggle financially might utilize less healthy options that tend to be less expensive.
Health Status: Other medical issues may have an effect on what the pt may or may not eat.
Identify individuals at risk for nutritional problems.
- Pt's c tooth loss or mouth pain
- Pt's who are immobile
- Those who have problems with ingestion, digestion or absorption
- Older adults >80
- PO pts
- Individuals who choose alternate food patterns
- Pt's who are NPO >5days
- Pt's with cancer, HIV, eating disorders, GI disease, critical illness, malabsorption problems, metabolic disease, renal disease and those with liver, pancreatic or gallbladder disease
Describe ways to assist pt's with meals.
- minimize odors
- use proper oral hygiene
- remove reminders of tx
- use proper positioning to facilitate eating
- serve hot meals within the pt's preference as ordered diet allows
- diet supplements and food the pt likes which is acceptable for them to eat.
Explain the following Diet Orders and give the rationale for each.
NPO- Nothin by mouth used anytime there is a ? abt GI fx, Pre & Post operatively, necessary for certain tests or they may be receiving parenternal nutrition.
Clear Fluid- include broth, bullion, coffee (w/o milk or cream), tea, carbonated beverages, clear fruit juices, gelatins &/or popsicles. They are used in preparation for certain diagnostic tests, pre-operatively or for pt's who are just restarting oral nutrition. The only source of calories for these pt's are sugars.
Full Liquid- Allows for the above diet plus smooth textured dairy products, custards, refined cooked cereals, vegetables, pureed veggies and all fruit juices. They can be given thru a PEG tube, NG tube or drank. A pt can receive a full nutrient diet this way.
Pureed- Allows for the above diet with the addition of scrambled eggs, pureed meats, vegetables, fruits, mashed potatoes and gravy. They tend to be the consistency of baby food.
Mechanical Soft- Allows for the above diets with the addition of ground or finely diced meats, flaked fish, cottage cheese, rice, potatoes, pancakes, bread, cooked veggies, canned fruit, soups and peanut butter. It is softer than a regular soft diet and can be done w/o teeth, it looks like more normal food and uses a small amt of energy to eat.
- Soft- Allows for the above diets with the addition of moist tender meats, poultry, fish, casseroles, soft fresh fruits, cakes and cookies w/o nuts. It required minimal chewing and is ordered for pt's who are debilitated or have mild GI problems.
- High Fiber- as above plus the addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal and dried fruits.
Regular- No restrictions unless specified.
Low Fat & Low Cholesterol- Indicated for pt's c heart disease, gallbladder disease, obesity and hypertension. To lower cholesterol avoid cheese, milk, meats, fats and baked goods. CHO = < 300mg/d and Na = < 2400mg/d. This is often called the "Cardiac Diet"
Diabetic Diet- follows the ADA guidelines, 50-60% of intake is in the form of carbs that is divided throughout each meal to keep a consistent carb intake, this helps avoid peaks and valleys. Calorie limits will be ordered specifically.
Renal Diet- ordered for pt's c kidney disease, there are restrictions on protein, fluid, K, Na and phosphorus (P) bc the kidneys aren't working and therefore excretion is hindered so we reduce the intake. This diet needs to come with a very specific order from the MD.
Dysphagia Diet- Ordered for pt's who have trouble swallowing or eating. It is not a nutrition problem it is a problem c consistency, so thin liquids are restricted bc they are hard to control. Liquids must me semi-thick to thick to avoid aspiration or choking.
Na Restriction- Ordered for pt's c HBP or heart failure. "No Salt Added" allows for a 4g/d of sodium. Normal restriction is 2-3g/d but may be restricted to 500mg for certain pt's.
Fluid Restriction- Ordered is the amt of fluid intake for a 24hr period, strict I&O and includes IV fluids. This is ordered for pt's who have renal (inability to excrete can cause a backup) or heart (decrease the workload on the heart) disease.
4 Levels of Liquid Diet; thin liquids (low viscosity), nectar-like liquids (medium viscosity), honey-like liquids (viscosity of honey) and spoon-thick liquids (viscosity of pudding)
Explain the rationale for enteral feedings.
- Enteral feedings are ordered for pt's who are incapable of eating due to injury or disease, or those at risk for aspiration.
- It is the preferred method of meeting nutritional needs if the pt's GI tract is functioning.
- Indicated if the pt is unable to ingest food but is still able to digest and absorb nutrients, pt's who cannot maintain adequate nutrition on oral intake alone, pt's who have poor neuromuscular control and cannot swallow or for pt's who are critically ill and cannot eat bc of their condition.
- Contraindications include pt's c diffuse peritonitis, pt's c severe pancreatitis, pt's c an intestinal obstruction, intractable diarrhea or vomiting or pt's c paralytic ileus (intestine don't move)
Compare and contrast formulas used for tube feedings.
- 3 Basic Groups include
- 1. blenderized
- 2. polymeric (milk based and lactose free)
- 3. elemental or monomeric
- Basic components in enteral solutions are:
- 1. carbs in the form of dextrose, sucrose, lactose and starch
- 2. protein in the form of intact proteins, hydrolyzed proteins and amino acids
- 3. fat in the form of corn oil, soybean oil or safflower oil
- 4. H20 enough to maintain sufficient hydration
Discuss the use of supplemental nutrients including vitamins, minerals and electrolytes. (Na & K)
K: necessary for the transmission and conduction of nerve impulses and for the contraction of skeletal/smooth/cardiac muscle; sources include bananas, fruit juice and vegetables
Na: is a major extracellular cation and is the major electrolyte that regulates body fluids; promotes the transmission/conduction of nerve impulses as it is part of the Na/K pump that causes cellular activity (when Na shifts in K shifts out); sources include canned foods, lunch meats,ham, pork, pickles, potato chips and pretzels
Identify nursing interventions to stimulate appetite.
- keep pt's environment free of odors
- provide oral care
- allow client to choose food as allowed by diet
Describe some aids that enable self feeding.
- provide a 30 min rest period before eating
- position the pt in an upright seated position in a chair
- have the pt slightly flex the head to a chin-down position to prevent aspiration
- have the pt place food on the stronger side of the mouth
Ice Chips/ Sips
List 7 dietary guideline for health promotion.
- adopt a balanced eating pattern with a variety of nutrient dense food and beverages among the basic food groups
- maintain body weight in a healthy range
- encourage physical activity and decrease sedentary activities
- encourage fruits, vegetables, whole-grain products and fat-free or low-fat milk while staying within energy needs
- keep total fat intake b/t 20 and 35% of total calories with most fats coming from polyunsaturated or monounsaturated fatty acids
- choose and prepare foods and beverages with little added sugars or sweeteners
- choose and prepare foods with little salt while at the same time eating K rich foods
- limit alcohol intake
- practice food safely to prevent microbial food-borne illnesses
Identify community services and resources to meet the nutritional needs of certain groups of the population.
Discuss the importance of diet counseling and teaching before a pt is discharged.
- Diet counseling and teaching are important before a pt's discharge bc early identification of potential or actual problems is the best way to avoid a more serious problem.
- Nurses are in a key position to educate a pt about good nutritional habits.
- Nurses assist the pt in incorporating knowledge of nutrition into lifestyle which serves to prevent many diseases
Discuss the recent trends in obesity and the role of nutrition.
Describe the steps and rationale of aspiration precautions.
- Action(A): observe clients during meal time for for signs of dysphagia; allow pt to attempt to feed themselves; observe consistencies of food; note after meal if pt is tired
- Rationale(R): helps to detect abnormal patterns of eating such as frequent clearing of throat or prolonged eating time. *fatigue increases risk for aspiration
- (A): Ask pt about any difficulties with chewing or swallowing various textures of food.
- (R): certain types of food are more easily aspirated than others
- (A): elevate HOB so that hips are flexed at 90 degree angle and head is flexed slightly forward
- (R): reduces the risk of aspiration
- (A): observe for coughing, choking, gagging or drooling of food
- (R): these are indications that suggest dysphagia and risk for aspiration
- (A): ask client to remain sitting upright for at least 30 mins after the meal
- (R): reduces the risk of gastroesophageal reflux, which causes aspiration
The nurses aide is preparing to bathe a comatose pt receiving Jevity at 65ml/hr via peg tube. What instructions would you give the nurses aide?
Your pt is NPO to rule out a bowel obstruction. You enter the room, the wife is feeding the pt and states "He's starving to death." What actions would you take?
Explain the significance of saturated, unsaturated and polysaturated lipids in nutrition.
Peptic Ulcer Disease (PUD)
H. pylori is a bacterium that causes peptic ulcers, and its presence can be confirmed by laboratory tests. It is treated with antibiotics that control the bacterial infection.