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Nutrients

Specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury

Essential Nutrients

Not synthesized in the body or are made in insufficient amounts

Essential Nutrients: Macronutrients

Supply energy and build tissue. Carbs, fats, protein

Essential Nutrients: Micronutrients

Required in smaller amounts to regulate and control body processes. Vitamins and minerals

Nonessential Nutrients

Don't have to be supplied by dietary sources because they're either not required for body functioning, or they are synthesized in the body in adequate amounts

The 6 Classes of Nutrients

3 supply energy (carbs, proteins, lipids) and 3 are needed to regulate body processes (vitamins, minerals, water)

When will a person's weight remain stable?

When daily energy intake is equal to total daily energy expenditure

Basal Metabolism

The 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

Examples of Basal Metabolic Activities

Maintaining body temp and muscle tone, producing and releasing secretions, propelling food through the GI tract, inflating the lungs, contracting heart muscle

Why do men have a higher BMR than women?

Larger muscle mass. BMR is 1 cal/kg of body weight per hour for men, and 0.9 cal/kg of body weight per hour for women

Factors that increase BMR

Growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (especially epinephrine and TH)

Factors that decrease BMR

Aging, prolonged fasting, sleep

Rule of Thumb Method (determining ideal weight based on height)

Women: 100 lb. (for height of 5 ft) + 5 lb. for each additional inch over 5 ft.
Men: 106 lb. (for height of 5 ft) + 6 lb. for each additional inch over 5 ft.
This method can result in unrealistically low figures for adults who are very short or very tall

Body Mass Index (BMI)

Weight in kg divided by height in meters squared (kg/m^2)
Weight in lbs divided by height in inches squared X 703

BMI Guidelines

<18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
30-34.9 = obesity class 1
35-39.9 = obesity class 2
40+ = extreme obesity

Calculating the Percent of Weight Change

usual weight - present weight / usual weight X 100

Considerate Weight Loss %s

1% to 2% in 1 week, 5% in 1 month, 7.5% in 3 months, 10% in 6 months

Method of Calculating Caloric Requirements

Multiply healthy weight in lbs by 10 for women and 11 for men, then multiply by the number given for activity level (1.2 sedentary, 1.3 light activity, 1.4 moderate activity, 1.5 high activity)
Male: 130 lb X 11 cal/lb = 1430 cal/day X 1.3(activity level) = 1690 total daily calories

Which organ stores glucose and regulates it's entry into the blood?

Liver

What hormones are especially important for keeping serum glucose levels fairly constant during both feasting and fasting?

Insulin and glucagon

Unlike ____ and ____, _____ is burned efficiently and completely, and does not leave a toxic product for the kidneys to excrete

Protein, fat, glucose

What does the body do when glycogen stores are adequate?

Converts excess glucose to fat and stores it as triglycerides in adipose tissue

Ketosis

Abnormal accumulation of ketone bodies that is frequently associated with acidosis. 50-100 carbs are needed daily to prevent this

Carbs should provide ____% to ____% of total calories, mostly in form of ____ carbs

45, 65, complex

How do amino acids in protein differ from carbs?

They contain N

____ amino acids are classified as essential, ____ are nonessential and can be synthesized in the body

9, 13

Proteins

Required for the formation of all body structures, including genes, enzymes, muscle, bone matrix, blood, skin

What is the only plant protein that is considered to be a complete protein?

Soy

Nitrogen Balance

Neutral N Balance: When catabolism and anabolism are occurring at the same rate (healthy individuals)
Positive N Balance: N intake is greater than excretion (growth, pregnancy, lactation, recovery from illness)
Negative N Balance: more N is excreted than ingested (undesirable, starvation, and catabolism that immediately follows surgery, illness, trauma, stress)

Protein consumed in excess of need is stored as ____

Fat (just like carbs)

Recommended daily intake of protein

0.8g/kg of desirable body weight. ~56g for average woman and 63g for average man

Protein intake should contribute to ____% to ____% of total caloric intake

10, 20

_____ compose 95% of the lipids in the diet. ____ lipids (such as ____) and ____ lipids (such as ____) constitute the remainder of the lipids ingested.

Triglycerides, compound, phospholipids, derived, cholesterol

Which type of fat raises serum cholesterol levels?

Saturated, unsaturated lowers serum cholesterol levels

Trans Fat

When manufacturers partially hydrogenate liquid oils, they become more solid and more stable. Raises serum cholesterol level so it is to be counted as a saturated fat

Cholesterol

Fat like substance only found in animal products. Nonessential. Important in cell membranes, especially abundant in brain and nerve cells.

Fat intake should be no more than ___% to ____% of total caloric intake, with less than ____% of fat calories from saturated fats and less than ____ mg/day of cholesterol

20, 35, 10, 300

Regulatory Nutrients

Water, vitamins, minerals. Needed by the body for the metabolism of energy nutrients

Vitamins

Organic compounds needed by the body in small amounts. Needed for metabolism of carbs, protein, and fat.

What 2 fat soluble vitamins are particularly toxic if taken in excess?

A and D

Minerals

Inorganic elements found in all body fluids and tissues in the form of salts (sodium chloride) or combined with organic compounds (ex: iron in Hb)

Macrominerals

Needed in amounts >100mg/day. Calcium, phosphorus (phosphates), sodium, sulfur (sulfate), chloride, potassium, magnesium

Microminerals

Trace elements, needed in amounts <100mg/day. Iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine.

Recommended Food Intake (fruits, vegetables, grains, milk, meat & beans)

2 cups of fruit, 2 1/2 cups of veggies, 6oz. of grains, 3 cups of milk, 5 1/2oz meat & beans

How long is breastfeeding recommended as the major source of nutrition?

6-12 months, cow's milk not recommended for infants under 1 years of age

When should solid foods be introduced to infants?

When they are developmentally ready, usually between 4-6 months

During the last 2 trimesters, normal weight women need an extra ____ calories/day

300

Key Nutrients Needed in Pregnancy

Protein, calories, iron, folic acid, calcium, iodine.

Competitive Nutrients

Some nutrients compete against each other for absorption, and excess of one may lead to a deficiency of another. (zinc and copper)

A patient taking gingko biloba (an herbal), aspirin, and Vitamin E (dietary supplement) is at risk for ____ ____

excessive bleeding because each of these substances have blood-thinning properties, therefore surgery may need to be postponed

How many adults in the US are overweight? Obese?

2/3, 1/3

Nutritional Screening: DETERMINE

Disease, Eating poorly, Tooth loss/mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss/gain, Needs assistance in self care, Elder years above 80

Mini Nutritional Assessment tool (MNA)

Used to detect elderly persons at risk for malnutrition before changes in albumin level and the BMI. Involves screening questions followed by anthropometric measurements (BMI, midarm and calf circumference, weight loss)

Easiest Way to Collect Dietary Data

24-hour recall method.

Most common anthropometric measurement?

Height and weight

Conditions that cause Dysphagia

Poor dental health, cancer, neurologic disease (stroke, Parkinson's, dementia)

Serum Albumin Levels

Good indicator of a person's nutritional status a few weeks prior to when the blood is drawn, and can help identify chronic nutrition problems. This level doesn't change with increasing age

Ways protein status can be determined

Hemoglobin/hematocrit tests, serum albumin levels, transferrin levels

____ levels are directly proportional to the body's muscle mass, and a reduction in this value reflects severe malnutrition

Creatinine

Progression of Diets

Clear liquids, full liquids, soft diet, normal/modified diet

Soft Diets

Regular diets that have been modified to eliminate foods that are hard to digest and to chew, including those that are high in fiber, fat, and seasoning. (called low fiber or bland diets)

Although unlikely, what are 3 vitamins that may need to be supplemented in vegetarian diets?

A, B12, iron.

Enteral Nutrition

Administering nutrients directly into the stomach

Parenteral Nutrition

Providing nutrition via IV therapy

Nasogastric Tube (NG tube)

Short-term use (less than 4 weeks), inserted through the nose into the stomach. Patient is at risk for aspirating the tube feeding solution into the lungs.

Levin Tube

NG tube. Flexible rubber or plastic single lumen tube with holes at the stomach end and a connector at the opposing end.

Dobbhoff Tube

NG tube. Smaller, softer, more pliable polyurethane tube. Provides greater patient comfort and less trauma to the nares. Smaller diameter makes checking tube placement and med admin more difficult than with the larger diameter tubes

Nasointestinal Tube (NI tube)

Passed through the nose and into the upper portion of the small intestine. Might be used for a patient with increased risk for aspiration due to a diminished gag reflex or slow gastric motility. Also avoids potential for gastric reflex. Used with some medical conditions (delayed gastric emptying, gastric tumor)

Dumping Syndrome associated with NI Tube

When formula is delivered directly into the intestine it bypasses the pyloric valve which normally slows transit of food into the intestine. Rapid admin of hypertonic feeding solution into the proximal small intestine causes movement of extracellular fluid from the vascular system into the small intestine. Distention occurs, causing gas, bloating, nausea, diarrhea, cramping, and lightheadedness

Carbon Dioxide Monitoring

Determines nasogastric tube position and/or dislodgment. involves use of capnograph or a colorimetric end-tidal CO2 detector. If CO2 is detected, NG tube is placed in the airway instead of stomach

Long-Term Nutritional Support

Enterostomal tube may be placed through an opening created into the stomach (gastrostomy) or into the jejunum (jejunostomy). Placement can be accomplished by a surgeon or gastroenterologist via a percutaneous endoscopic gastrostomy (PEG) or a surgically placed gastrostomy tube

Residual

Feeding remaining in the stomach. Needs to be checked every 4-6hrs during continuous feeding, or before each feeding if not continuous. 200-250mL+ is a high gastric residual volume and is associated with a high-risk of aspiration and aspiration-related pneumonia.

To what degree should the bed be elevated during gastric feedings, and how long after does it need to remain at that degree?

30 degrees, 1hour. Prevents reflux and aspiration

Replace a disposable feeding apparatus for open systems every ____ hrs, closed systems can be used up to ____ hrs

24, 48

Should you give meds through a feeding tube while a feeding is being infused? Why?

NO! Some drugs become ineffective when mixed with feeding formulas. Meds mixed in feeding formulas may cause clogging of feeding tube. Give meds in liquid form whenever possible, and flush the tube with water before, between, and after the admin of meds

What to do if feeding tube gets clogged

Use a 60mL syringe to flush 30-60mL of warm water through the tube in attempt to unclog

Other uses for nasogastric tubes besides feeding

Decompress/drain stomach of fluid, unwanted stomach contents (poison, meds, air), allowing it to rest, or before/after surgery to promote healing. Also used to monitor GI bleeding and prevent intestinal obstruction.

Why Parenteral Nutrition may be used

Nonfunctional GI tract, comatose, patient has high caloric and nutritional needs due to illness or injury, patient undergoing aggressive cancer therapy and those recovering from extensive burns, surgery, sepsis, multiple fractures, etc.

How can parenteral nutrition be administered?

Centrally through a central venous access device (TPN) or peripherally (PPN) through a short term intravenous access through a peripheral vein. Basic difference between these 2 types is the concentration of the solutions infused.

Total Parenteral Nutrition (TPN)

Highly concentrated, hypertonic nutrient solution. Provides calories, restore N balance, and replaces essential fluids, vitamins, electrolytes, minerals, and trace elements. Can promote tissue and wound healing, and normal metabolic function

Peripheral Parenteral Nutrition

Less concentrated nutrient solution sometimes prescribed for patients who have a malfunctioning GI tract and need short term nutrition lasting less than 2 weeks. Administered through a peripheral vein (can't tolerate highly concentrated fluid)

Kayexalate

Treats high potassium levels in the blood. Binds with K then gets excreted in the stool.

REE

resting energy expenditure

Simple Carbs vs. Complex Carbs

Simple= sugar, complex= starches (rice, potatoes, bread)

1 carb= ____ g

15

Indispensable Amino Acids

We can't synthesize in body. histidine, lysine, phenylalanine

Dispensable Amino Acids

We synthesize in body. Alanine, asparagine, glutamic acid

Vitamins act as ____ to help ____ energy from food molecules during metabolism

catalysts, release

Vitamin A

Affects visual acuity, skin and mucous membranes, and immune function. Skin can turn orange (orange foods like carrots, squash, sweet potatoes)

Vitamin D

Provides calcium and phosphorus metabolism and stimulates calcium absorption

Vitamin E

Antioxidant that protects vitamin A

Vitamin K

Helps the synthesis of certain proteins necessary for blood clotting

Religious Views on Food (Mormon, Hindu, Islam & Judaism)

Mormons do not drink tea, coffee or alcoholic beverages, limit meat consumption. Islam and Judaism avoid pork. Hinduism = no beef

Extrusion Reflex

Reflex in babies meaning they can't swallow solid food yet

Iron stores deplete at ____ to ____ months, therefore Iron fortified cereal needs to be eaten for at least 1 month

4, 6

If person has ____ or ____ ____ ____, limit potassium to almost nothing

chronic, acute, renal failure

If a person is on a Statin drug, what should they not consume?

Grapefruit or grapefruit juice

What is the cause if a patient gains 3-5lbs over 24hours?

Water retention

If a patient has chronic renal failure they are going to have low ____ and ____.

Albumin, pre-albumin

NG Tube Placement

measure tip of nose to earlobe to xiphoid process (if need to go duodenal or jejunal add 20-30cm to length)

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