Chapter 44 Nutrition

Created by Ajorgensonstough 

Upgrade to
remove ads

You are teaching a client about healthy nutrition. You recognize that the client understands the teaching when he states:

i will make sure that I eat a balanced diet and exercise regularly

As a nurse, you teach a client who has had surgery to increase which nutrient to help with tissue repair?

Protein

You are caring for a client experiencing dysphagia. Which interventions will help decrease the risk of aspiration during feeding?

Sit the client upright in a chair.
Place food in the strong side of the mouth.
Feed the client slowly, allowing time to chew and swallow.

The nurse suspects that the client receiving PN through a CVC has an air embolus. What action does the nurse need to take first?

Turn client to left lateral decubitus position.

Which action is initially taken by the nurse to verify correct position of a newly placed small-bore feeding tube?

Place an order for x-ray examination to check position.

The catheter of the client receiving PN becomes occluded. Order the steps for caring for the occluded catheter in the oder in which you would perform them.

Attempt to aspirate a clot.
Temporarily stop the infusion.
Flush line whit saline or heparin.
Use a thrombolytic agent if ordered or per protocol.

Based on knowledge of peptic ulcer disease (PUD), the nurse anticipates the presence of which bacteria when reviewing the lavoratory data for a client suspected of having PUD?

Helicobacter pylori

You are assessing a client receiving enteral feedings via a small-bore nasogastric tube. Which assessment findings need further intervention?

Gastric residual aspirate of 300 mL for the second consecutive time

The home care nurse is seeing the following clients. Which client is at greatest risk for experiencing inadequate nutrition?

A recently widowed 76-year-old woman recovering from a mild stroke

Basal Metabolic Rate (BMR)

Energy (kcals) needed to maintain life-sustaining activities such as breathing, circulation, heart rate and temperature, for a specific period of time at rest.

Things that factor energy requirements

injury, infection, activity level, thyroid function, age, body mass, gender, fever, starvation, menstruation, illness.

Resting Energy Expenditure (REE) or Resting Metabolic Rate

The amount of energy an individual needs to consume over a 24 hour period for the body to maintain all its internal working activities while at rest.

Factors that affect metabolism

illness, pregnancy, lactation, activity level.

Carbohydrates

Main source of energy in the diet. Each gram of carbogydrate produces 4 kcal and serves as the main source of fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocte prodcution, and cell function of the renal medulla.

Foods that contain carbohydrates

Plants and milk products

2 Simple Carbohydrates

Monosaccharides and Disaccharides

Monosaccharide

Glucose, dextrose, fructose. Cannot be broken down further.

Disaccharide

Sucrose, lactose, maltose. Made up of two monosaccharides and water.

Complex Carbohydrate

Polysaccharide

Polysaccharide

Glycogen, starches, fiber. Body is unable to break these down. Insoluble in water.

Proteins

Each gram provides 4 kcal. Essential for body growth and repair. Collagen, hormones, enzymes, DNA, RNA, blood clotting, fluid regulation, acid-base balance.

Amino Acid

Simplist form of a protien.

Food sources of protien

Meats, beans and cheese.

Nitrogen Balance

When enough carbs are in the diet, protien is spared as an energy source. This allows for growth and repair, wound healing, normal pregnancy, maintenance of vital organs. You need a positive nitrogen balance for growth, pregnancy and maintenance of muscle mass and vital organs.

nitrogen balance indicates

Occurs when the body loses more nitrogen then it gains. Infection, sepsis, burns, fever, trauma

Positive Nitrogen Balance

When intake of nitrogen is greater than the output. This allows for growth and repair, wound healing, normal pregnancy, maintenance of vital organs. You need a positive nitrogen balance for growth, pregnancy and maintenance of muscle mass and vital organs.

Fats (Lipids)

Provide 9 kcals/g. Composed of triglycerides and fatty acids.

Saturated Fatty Acids

Each carbon in the chain has two attached hydrogen atoms.

Unsaturated Fatty Acids

Enequal number of hydrogen atoms are attached and the carbon atoms attach to each other with a double bond.

Composition of fatty acids

Chains of carbon and hydrogen atoms with an acid group on one end of the chain and a methy group at the other.

Monounsaturated fatty acid

have one double bond

Polyunsaturated fatty acids

have two or more double bonds.

Linoleic acid

Only unsaturated fatty acid that is essential for humans.

Fat deficiency

Fat intake below 10% of daily nutrition.

Food source with high proportions of saturated fatty acids

animal fats

Food source with high proportions of unsaturated fatty acids

vegetable fats

60-70% of total body weight

Water

Factors that effect unequal intake and output

Illness can increase fluid needs. Some illnesses decrease the ability to excrete fluid, leading to the need for fluid restriction such as renal disease.

How we meet our water intake needs

Ingesting fluids and foods with high water content.

A way the body produces water

During digestions when food is oxidized.

Vitamins

Organic substances present in small amounts in foods that are essential to normal metabolism. They are used as catalysts in biochemical reactions.

Minerals

Inorganic elements that are essential to the body as catalysts in biochemical reactions.

Fat-soluble vitamins

A, D, E and K. Stored in the fatty compartments of the body. With the exception of vitamin D, these vitamins are provided through dietary intake.

Hypervitaminosis of fat soluble vitamins

Results from megadoses (intentional or unintentional) of supplemental vitamins, excessive amounts in fortified food and large intake of fish oils.

Water-soluble vitamins

C, and B complex (which is 8 vitamins). The body does not store water soluble vitamins, so these need to be provided in the daily intake of food. Although these vitamins are not stored, toxicity can still occur.

Enzymes

Protein like substances that act as catalysts to speed up chemical reactions and are an essential part of the chemistry of digestion.

Mouth

Breaks down food particles.

Salivary glands

Moistens and lubricates food. Amylase digests carbs.

Pharynx

Swallows

Esophagus

transports food

Stomach

Stores and churns food. HCL activates enzymes, breaks up food, kills germs. Mucus protects stomach wall. Limited absorption.

Small intestine

Completes digestion. Mucus protects gut wall. Absorbs nutrients, most water.

Large intestine

Reabsorbs some water, ions and vitamins. Forms and stores feces.

Rectum

Stores and expels feces.

Anus

Opening for elimination of feces.

Gallbladder

Stores and concentrates bile.

Pancreas

Hormones regulate blood glucose levels. Bicarbonates neutralize stomach acid.

Liver

Breaks down and builds up many biological molecules. Stores vitamins and iron. Destroys old blood cells. Destroys poisons. Produces bile to aid digestion.

Pathway of digestion

Mouth, Phyarynx, Esophagus, Stomach, Small Intestine, Large Intestine, Rectum, Anus

Chyme

Food leaves the distal stomch, through pyloric sphincter and enters the duodenum, food is now this acidic, liquefied mass.

4 stages of food intake and output

digestion, absorption, metabolism and storage of nutrients, eliminaion

Metabolism

all the biochemical reactions within the cells of the body. Can be anabolic or catabolic

Anabolism

building of more complex biochemical substances by synthesis of nutrients. Occurs in a state of positive nitrogen balance.

Catabolism

Breakdown of biochemical substances into simpler substances and occurs during a state of negative nitrogen balance.

Glycogenolysis

Catabolism of glycogen into glucose, carbon dioxide, and water.

Glycogenesis

Anabolism of glucose into glycogen for storage.

Gluconeogenesis

Catabolism of amino acids and glycerol into glucose for energy.

Dietary Reference Intakes (DRI's)

Present evidence based criteria for an acceptable range of amounts of vitamins and nutrients to avoid deficiencies or toxicities for each gender and age group.

4 components a DRI

Estimated average requirement (EAR), Recommended dietary allowance (RDA), Adequate intake (AI), tolerable upper intake level (UL).

Estimated average requirement (EAR)

recomended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population based on age and gender.

recommended Dietary Allowance (RDA)

Average needs of 98% of the population, not the exact needs of the individual

Adequate intake (AI)

the suggested intake for individuals based on observed or experimentally determined estimates to set the RDA.

Tolerable Upper intake level (UL)

The highest level that likely poses no risk of adverse health events. It is not the recommended level of intake.

Food pyramid

basic guide for buying foods and meal preparations. Includes daily intake of grains, vegetables, fruits, milk, meat and beans.

Benefits of breast-feeding

reduced food allergies and intolerances; fewer infant infections, easier digestion; convenient, always correct temperature, available and fresh; economical; increased time for mother and infant interaction

Formula

protein in formula is typically whey, soy, cow's milk base, casein hydrolysate, or elemental amino acids

Reasons not to use cow's milk

infants less than 1 year of life, can have gi bleeding, it is too concentrated for the infant's kidneys to manage, increases the risk of milk product allergies, and is a poor source or iorn and vitamins C and E

poor oral health can cause the following diseases:

bacteremia, endocarditis, cardiopulmonary disease, dm, and adverse outcomes in pregnancy

Vegetarianism

diet consisting predominantly of plant foods

Ovolactovegetarian

eat eggs and milk

lactovegetarian

ovoid eggs but drink milk

vegans

eat only plant food

Zen macrobiotic

eat primarily brown rice, other grains, and herb teas

Fruitarian

eat only fruit nuts honey and olive oil

Analgesic: Acetaminophen

Decreased drug absorption with food; overdose associated with liver failure

Analgesic: Aspirin

Absorbed directly through stomach; decreased drug absorption with food; decreased folic acid, vitamins C and K, and iron absorption

Anatacide: Aluminum hydroxide

Decreased phosphate absorption

Sodium bicarbonate

Decreased folic acid absorption

Antiarrhythmic: Amiodarone

Taste alteration

Antiarrhythmic: Digitalis

Anorexia, decreased renal clearance in older persons

See Table 44-2 for other Drug nutrient interactions pg. 1095

pg 1095

Anthropometry

measurement system of the size and makeup of the body; height and weight obtained

ideal body weight (IBW)

compare height and weight to standards for height weight relationships

Body Mass Index (BMI)

measures weigt corrected for height and serves as alternative to traditional height-weight relationships. calculate BMI by dividing the client's weight in kilograms by height in meters squared

dysphagia

refers to difficulty when swallowing, causes can be neurogenic, myogenic, and obstructive

Complications of dysphagia

aspiration pneumonia, dehydration, decreased nutritional status, and weight loss

Signs of Dysphagia

cough during eating; change in voice tone or quality after swallowing; abnormalmovements of the mouth, tongue, or lips; and slow, weak, imprecise, or uncoordinated speech

other signs of dsyphagia

Abnormal gag, delayed swallowing, incomplete oral clearance or pocketing, regurgiatation, pharyngeal pooling, delayed or abesnt trigger of swallow and inbaility to speak consistently

Organism, food source and symptoms of Botulism

C. botulinum. Improperly home-canned foods, smoked and salted fish, ham, sausage, shellfish. Symptoms are varied from mild discomfort to death in 24 hours, initially nausea and dizziness, prgressing to motor (respiratory) paralysis.

Organism, food source and symptoms of Escherichia Coli

E. Coli. Underooked ground beef. Severe cramps, nausea, vomitting, diarrhea (may be bloody), renal failure. Appears 1-8 days after eating and lasts 1-7 days.

Organism, food source and symptoms of listeriosis

Listeria or L. monocytogenes. Soft cheese, meath (hot dogs and lunch meats), unpsteurized milk, poultry, seafood. Severe diarrhea, fever, headache, pneumonia, meningitis, endocarditis. Appears 3-21 days after infection.

Organism, food source and symptoms of Perfringens enteritis

Clostridium or C. perfringens. Cooked meats, meat dishes heald at room or warm temp. Mild diarrhea, vomiting. Appears 8-24 hours after eating, lasts 1-2 days.

Organism, food source and symptoms of Salmonellosis

Salmonella or S. typhi, S. paratyphi. Milk, custards, egg dishes, salad dressings, sandwich fillings, polluted shellfish. Mild to severe diarrhea, cramps, vomitting. Appears 12-24 hours after ingestion, lasts 1-7 days.

Organism, food source and symptoms of Shigellosis

Shigella or S. dysenteriae. Milk, milk products, seafood and salad. Mild diarrhea to fatal dysentery. Appears 7-36 hours after ingestion; lasts 3-14 days.

Organism, food source and symptoms of Staphylococcus

Staphylococcus or S. aureus. Custards, cream fillings, processed meats, ham, cheese, ice cream, potato salad, sauces, casseroles. Severe abdominal cramps, pain, vomiting, diarrhea, perspiration, headache, fever, prostration. Appears 1-6 hours after ingestion, lasts 1-2 days.

Clear liquid diet

broth, coffee, tea, clear fruit juices, jello, popsicles.

Full liquid diet

smooth-textured dairy products (ice cream), custard, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices.

Pureed diet

Scrambled eggs, pureed meats, vegetables, and fruits; mashed potatoes and gravy

Mechanical soft diet

Ground or finely diced meats, flacked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter.

Soft/low residue diet

Low fiber, easily digested foods such as pasta, casserole, moist ender meat, canned cooked fruits or vegetables. Desserts, cakes and cookies without nuts or coconut

High fiber diet

Fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruit.

Low sodium diet

4g (no added salt), 2g, 1g or 500 mg sodium diet. These diets vary from no added salt to severe sodium restriction that requires selective food purchases.

Low cholesterol

300 mg/day. Keeps with AMA's guidelines for serum lipid reduction

Diabetic

Usually the caloric intake recommended is 1800/day. The diet needs to include a balanced intake of carbs, fats, and protiens. Caloric recommendations vary to accommodate the client's metabolic demands.

Regular diet

No restrictions, unless specified.

Parenteral nutrition (PN)

form of specialized nutrition support in which nutrients are provided intraveneously.

Lipid emulsions

Provide supplemental kcals and prevent essential fatty acid deficiencies.

Enteral tube feeding complications

pulmonary aspiration, diarrhea, constipation, tube occlusion, tube displacement, abdominal cramping, n&v, delayed gastric emptying, serum electrolyte imbalance, fluid overload, pyerosmolar dehydration, electrolyte imbalance, hyercapnia, hypo/hyperglycemia, hyperglycemic hyperosmolar nonketotic dehydration/coma (HHNC)

Medical nutrition therapy (MNT)

use of specific nutritional therapies to treat an illness, injury or condition.

treatment of Malabsorption symptoms

gluten free diet

Diabetes mellitus Type 1

Requires both insulin and dietary restrictions for optimal control

Diabetes millitus Type 2

Controlled with exercise and diet therapy

nutrition

the study of how food nourishes the body

nutrients

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

macronutrients

essential nutrients that supply energy and build tissue ( such as carbohydrates, fats, and protien) provides calories

micronutrients

vitamins and minerals, are required in much smaller amounts to regulate and control body processes does not provide calories

calories

energy in the diet is measured in the form of kilocalories, commonly abbriviated as cal.

carbohydrates, protein, and fat

provide energy

vitamins and minerals

needed for the metabolism of energy, do not provide calories

kCalories

a measure of energy, the amount of energy that carbohydrates, fats, and protein release

carbohydrates ____kCall = _____ gm

4kcal=1gm

protein ____kCall = _____ gm

4kcal=1gm

fat ____kCall = _____ gm

9kcal=1gm

fat

has a greater energy density, a kind of body tissue containing stored fat that serves as a source of energy

weight gain

if energy intake exceeds energy expenditure you will gain weight

basal metabolism

energy required to carry on the involuntary activites of the body at rest

body mass index (BMI)

ideal body weight

carbohydrate

A class of nutrients made of sugars; these nutrients include sugar, starch, and fiber. All but fiber provide energy. Often referred to in the plural, carbohydrates.

glucose

the form of sugar that circulates in the blood and provides the major source of energy for body tissues. When its level is low, we feel hunger.

monosaccharides

simple sugars (glucose, galactose (from milk), fructose (from fruit))

disaccharides

Carbohydrates that are made up of two monosaccharides, Sucrose, Lactose, Maltose

polysaccharides

, carbohydrates that are made up of more than two monosaccharides.starch, glycogen, and fiber

liver and muscles

where the body stores much of its glucose and glycogen

normal blood sugar

70-100 mg/dl

hypoglycemia

abnormally low blood sugar usually resulting from excessive insulin or a poor diet <70 mg/dl

hyperglycemia

abnormally high blood sugar usually associated with diabetes > 126 mg/dl

prediabetes

diagnosed when fasting glucose levels are higher than normal (100 mg/dl) but lower than 126 mg/dl; people with prediabetes usually develop type II diabetes within 10 years; treat with weight loss and exercise to prevent onset of type II diabetes

insulin and glucagon

work together to keep the level of glucose in the blood stable. insulin stimulates cells in the liver and muscles to remove sugar from the blood and store it as glycogen or fat. glucagon stimulates the liver to break down glycogen and release glucose back into the blood. also stimulates the release of fatty acids from stored fats. made in the pancreas

soluble fiber

water soluble slows gastric emptying, lowers serum cholseterol level, delays glucose absorption, helps improve glucose tolerance, forms gels, easily digested by bacteria in the human large intestine, Sources-fruits, oats, barley, and legumes

See More

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set