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Nursing - Nutrition

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Definition of Nutrition
Processes involved in eating and using food to provide energy for the functions of our organs, for the movement of our body, also helps in maintenance of body temperature, provides raw material for the functions of enzymes for growth, for cell replacement, for the repair of cells and tissues
What nutrition is:
What we eat and how our body uses the food
Nutrition important:
- In prevention of disease
- In healing process
5 basic processes involved in body's use of nutrients:
- Ingestion
- Digestion
- Absorption
- Metabolism
- Excretion
INGESTION
Food taken into digestive tract
Orally
Feeding tubes
- NG
- GT
DIGESTION
Breakdown of foods into simpler forms for absorption
Mastication (chewing), churning, mixing
Food w/ enzymes and saliva
- Chemical breakdown of food taking place
Hormones
Control flow of digestive juices
Enzymes
Protein like substances act as catalysts to speed up biochemical reactions
- Essential for digestion to take place
Deglutition - esophagus - peristalsis - stomach
-Digestion begins in mouth, once food chewed/swallowed (Deglutition) then enters esophagus, moved along by peristaltic waves, enters stomach where remain for varying amounts of time (around 3 hours)
-Length of time in stomach depends on:
Type of food eaten, gastric motility, psychological influences
Chemical digestion
Carbs, proteins, fats
Make nutrients available for absorption
Chyme
Food leaves stomach as acid, liquified mass
Chyme flows into
- duodenum and continues to move along by peristalsis in small intestine mixing w/ secretions
- Major portion of digestion takes place in small intestine
ABSORPTION
- End products of digestion
- Pass through small intestines membranes where absorbed by blood and lymph system
Intestinal contents move by peristalsis into large intestine
- Water absorbed through membrane
- Rest of intestinal contents excreted as waste products
METABOLISM
- Process of converting nutrients into energy by the body
- Sum total of all chemical reactions that occur in living cells
2 Processes of Metabolism
Anabolism
Catabolism
Anabolism
build-up
- Production of more complex chemical substances
- Occurs by combining nutrients
- Results in formation of new tissue
- Requires energy
- Occurring continuously in body
Catabolism
break-down
- Breaking down of chemical substances into simpler substances
- Produce some energy but requires energy to do process
In healthy adult
Rate of catabolism = rate of anabolism
Metabolic rate
- Rate of energy utilized by the body
- Usually expressed in calories
Calorie
Amount of heat required to raise temperature of one gram of water by one degree Celsius
Kilocalorie
- Represents energy values of food
- Each kilocalorie = 1000 calories
Basal Metabolism
Amount of energy required to maintain physiological functions for involuntary activities of the body when body at rest
- Respirations, circulation, muscle tone
Basal Metabolism influenced by body composition
- Lean tissue require more calories to maintain than someone w/ more fat tissue
- Loss of lean tissue as age (esp women) one reason why energy requirements decrease as ppl get older - bc losing lean tissue
- Decrease in thyroid hormones - also cause lower rates of metabolism
- Increase in thyroid hormones - increase rate of metabolism
EXCRETION
Removal of waste material from the body
Physical indicators of sound nutrition:
- Alert, responsive
- Weight normal
For height, age, and body build
- Good posture
No malformations in posture
- Well developed muscles
Firm, good tone
- Good attention span, normal reflexes, psychological stability
- Good appetite, digestion, regular elimination
- Normal heart rate, rhythm, BP
For age
- Sleep well, energetic
- Shiny, lustrous hair, healthy scalp
- Smooth, moist skin - good color
- Pink oral membranes
No swelling
No lesions
- Eyes bright, clear
- Nails firm, pink
Physical indicators of inadequate nutrition:
- Listless, apathetic
- Overweight, underweight
- Poor posture
Hunched, slouching
- Flaccid, poor muscle tone
- Inattentive, irritable, confused
- Anorexia, indigestion, constipation, diarrhea
- Rapid heart rate, abnormal rhythm, elevated BP
- Fatigued, no energy
Fall asleep easy
Feel tired
- Stringy, dry, brittle thin hair
- Rough, dry, pale skin
- Oral membranes swollen
Gums inflamed
- Eyes dull, pale, dry
- Nails brittle
Nutritional History Components
- Food allergies
- Physical activity
Amount, level
- Cultural, socioeconomic, religious restrictions
- Personal preferences
What foods like/dislike
- Psychological factors
- Perception of food
- Alcohol and drug use
- Food fads or concerned w/ diets
METHODS TO OBTAIN NUTRITIONAL HISTORY
- 24 - hour recall
- Food-frequency questionnaire
- Food record
- Diet history
FACTORS INFLUENCING NUTRITION
- Culture
- Religion
- Socioeconomic
- Fads
- Superstitions
- Preferences
Nutrients
- Chemical substances supplied by food
- Body needs for growth, maintenance and repair
6 classes of nutrients:
- Carbohydrates
- Fats
- Proteins
- Vitamins
- Minerals
- Water
Simple Carbohydrates "sugars"
Monosaccharide
Disaccharide
monosaccharide
"one glucose molecule"
- glucose
- fructose
- galactose
Absorbed without undergoing digestion, used immediately as energy or stored as glycogen
glucose
(dextrose)
- fruit, vegetables, honey, corn syrup
fructose
(fruit sugar)
- fruit, honey
galactose
- Not found in appreciable amount in food
- Combined w/ glucose to make Lactose
Disaccharide
"two sugar molecules"
- sucrose
- maltose
- lactose
In order to be absorbed, must be separated into monosaccharide components through digestion first
sucrose
(table sugar)
- We refer to as sugar
- Formed from glucose and fructose
maltose
- two glucose molecules
- not normally found in food
lactose
(milk sugar)
- Glucose and galactose combined
- Found naturally in milk
- Enhances absorption of calcium
- Promotes friendly growth of bacteria in intestines to produce vitamin K
1 tsp of sugar
4 grams
Complex Carbohydrates "starches"
Polysaccharides "many sugars"
polysaccharides
- starch
- glycogen
- fiber
starch
- storage form of glucose in plants
- most abundant in grains, legumes, starchy vegetables - corn, potatoes
glycogen
- carbohydrate made in liver, stored in liver and muscles
- used between meals to maintain blood glucose levels and to provide fuel for tissues
- glycogenisis
- glycogenolysis
- glucose metabolism depends on insulin
glycogenisis
process of converting glucose to glycogen
glycogenolysis
process of changing glycogen back to glucose
insulin
pancreatic hormone used by cells to produce energy and for the liver to produce and store glycogen
fiber
- roughage, residue
- body unable to break down fiber
eliminated as waste material
- insoluble fiber
- soluble fiber
- dietary fiber has no nutritional benefit because body cannot digest but does aid in elimination - adds volume to stool, helps lower blood cholesterol
insoluble fiber
does not dissolve in water
- includes cellulose - holds water, aids in prevention or release of constipation
- sources: whole grains, wheat bran, legumes, vegetables, skins of fruit, shell of corn kernels
soluble fiber
- includes gum, pectins, etc.
- slows gastric emptying and movement of chyme through intestines
- delays absorption of glucose from small intestines
- helps lower blood cholesterol
- sources: fruits, oats, barley, legumes, broccoli
complex carbs digested more slowly than simple carbs
also supply body w/ energy for a longer period of time
digestion of carbs
- Mix w/ salivary enzyme ptyalin
- Little digestion occurs until reaches small intestine
- >Pancreatic and intestinal enzymes break down carbs
- >Breaks down complex carbohydrates then used completely by body
absorption of carbs
- Glucose, fructose, galactose - absorbed through intestinal mucosa cells
- Travel to liver - converted into glucose
metabolism of carbs
- Glucose released into bloodstream - move into cells (to meet energy needs)- stored in liver (as glycogen) - remaining glucose converted to fatty acids and stored as fat
Daily requirements of carbohydrates
- 50-60% total calories per day
- Each gram = 4 calories
deficiency of carbs
- Mild - result in fatigue, weight loss
- Significant - causes ketosis = abnormal accumulation of ketones (chemical compound)
- Ketosis often seen in diabetics, ppl who suffer from starvation
Can lead to coma, or death
Serious abnormality
excess carbs
- obesity - stored as adipose tissue
PROTEINS
- Composed of amino acids (building blocks)

- Organic compounds made up of hydrogen, carbon, oxygen, nitrogen

- Contained in every living cell
2 types of amino acids:
- essential amino acids (9)
- non-essential amino acids (11)
essential amino acids
- 9
- cannot be made by the body
- must be consumed through food
non-essential amino acids
- 11
- can be produced in liver if nitrogen and other precursors are available
in order for the body (cells) to produce proteins it needs/must have
20 amino acids
all tissues and fluid contain protein except for
urine and bile
FUNCTIONS OF PROTEINS
1) Needed in order for body to grow, repair itself, maintain structures
2) Facilitate specific chemical reactions in body
- Enzymes are proteins
3) Regulate specific body processes
- Hormones: insulin; neurotransmitters: serotonin; antibodies
4) Regulate fluid balance
- Attract water
- Albumin - not enough = edema
5) Acid-base balance
- Amino acids both acid and base so can regulate the pH
6) Transport other substances through blood
- Hemoglobin - transports oxygen
7) Provide energy (gluconeogenesis - convert amino acids to glucose) especially if carbs and fats are inadequate
digestion of proteins
- Chemical digestion of proteins begins in stomach when hydrochloric acid converts to pepsinogen and then enzyme pepsin
Pepsin in turn breaks down protein
- Most of digestion in small intestine
Pancreatic and intestinal enzymes reduce proteins to amino acid
absorption of proteins
- Proteins reduced to amino acids - amino acids absorbed through mucosa lining of small intestine
- Released into blood stream - transported to liver
metabolism of proteins
- Liver uses amino acids it needs, releases amino acids needed elsewhere in body, store the rest as glucose, glycogen, or fat
- Body not able to store amino acids
PROTEIN SYNTHESIS
- Complicated efficient process in which amino acids are assembled in order to create proteins needed by body

- Ability to replicate specific proteins in the body is determined through genetic codes contained in DNA

- Proteins either break down (Catabolism) or will be built up (Anabolism)
NITROGEN BALANCE
Cells continuously make proteins to replace those proteins broken down/lost through catabolism
Say that body is in neutral nitrogen balance:
- When amount of protein made during anabolism = amount of protein lost in catabolism
- Healthy adults should be in neutral nitrogen balance
positive nitrogen balance
- When production of protein greater (anabolism) than amount of protein broken down (catabolism)
- Examp: during pregnancy
negative nitrogen balance
- When protein breakdown exceeds protein production
- examp: starvation
- undesirable state
DAILY REQUIREMENTS OF PROTEINS
Determined by the body according to amount of protein needed to maintain neutral nitrogen balance
Factors determine amount of protein needed by body:
- age
- gender
- growth
- body weight
- muscle mass
- pregnancy
- stress
- infection
- healing process
- factors increase need for more protein by body
who requires a protein restriction
people with liver disease and renal failure because they cannot excrete nitrogenous waste material
daily requirements of protein
15-20% total calories per day
1 gram of protein
4 calories
sources of proteins
- complete proteins
- incomplete proteins
- complimentary proteins
complete proteins
- Those that provide all 9 essential amino acids so body can maintain tissues and growth
- All animal sources except gelatin
- Soy protein (plant protein)
incomplete protein
- Proteins in which one or more of essential amino acids is missing
- All plant proteins except soy protein
complimentary protein
- Combination of two incomplete proteins or small amount of complete protein combined with and incomplete protein so that there are sufficient quantities and proportions of all 9 amino acids
Fats (lipids) composed of:
carbon, hydrogen, oxygen
fats are a group of water-insoluble organic compounds including
- triglycerides (fats, oils)
- phospholipids
- sterols (cholesterol)
all fats contain a mixture of
saturated, monounsaturated, and polyunsaturated fatty acids
types of fats
saturated
unsaturated
saturated fat characteristics
- solid at room temp
- high melting point
- more stable than unsaturated fats - less likely to become rancid
- animal in origin except for tropical oils (cocoanut, palm)
unsaturated fats
characteristics:
- soft or liquid at room temp
- low melting point
- susceptible to rancidity when exposed to light, oxygen, or prolonged period of time
- predominately found in plant fats and oils, except tropical oils
unsaturated fats can be further divided
monounsaturated
polyunsaturated
visible fat
fat that surrounds piece of steak, butter
not visible fat
fat found in cheese, cookies, baked goods, etc.
sources of fat
animal fat
- lard, egg yolks, milk
- account for 57% total fat intake
vegetable fat
- plant oils (corn, safflower), nuts
- account for 43% total fat intake
transfatty acids
- Commercially baked goods, fried foods, hard margarin/shortening, crackers, biscuits, some cake mixes, candy, animal crackers/cookies, frozen waffles/pancakes, popcorn
- Look at labels
Functions of fat
- provide us with energy (carbs main source)
- support and protect internal organs
- assist w/ temperature regulation - insulation
- necessary for absorption of fat-soluble vitamins
digestion of fat
- Little occurs in stomach - most occurs in small intestine
- Bile released by gal bladder - helps prepare fat for digestion
- Pancreatic enzymes assist w/ digestion of fat
- End products of fat are fatty acids and glycerol
absorption of fat
- Most absorbed into small intestine (95%)
Some escape digestion - excreted in feces
- Cholesterol absorbed as is
Does not undergo digestion
storage of fat
- not immediately needed by body stored as adipose tissue
lipoproteins
- VLDLs: 50% triglycerides (true fat)
- LDLs: 50% cholesterol (bad cholesterol)
- HDLs: 50% protein (good cholesterol)
daily requirements of fat
- no more than 20-25% caloric intake per day
1 gram of fat
9 calories
VITAMINS
- Organic compounds made of: Hydrogen, carbon, oxygen, and sometimes nitrogen or other elements

- Promote biochemical reactions within cells to assist in regulating body processes such as growth and metabolism

- Essential to life/Need vitamins
vitamins may be susceptible to destruction and loss of function
- Susceptible to light, heat, alkalize, etc.
- Come in bottle where light cannot get to them
types of vitamins
- fat-soluble
- water-soluble
fat-soluble vitamins
- Vitamins A, D, E, K
- Absorbed with fat into lymph system
- Attach to protein characters so they can be transported through the blood
- Stored in liver and in adipose tissue when in excess - not excreted
- Toxic when large doses consumed - toxicity
Vitamin A, D
- Do not have to be eaten daily
Can be taken from storage
- Found in fat and oil portion of food
Function of Vitamin A
Night vision; growth; development bones and teeth; maintain skin and membranes; immune function
Function of Vitamin D
- Maintains serum calcium concentrations; needed for absorption of calcium and phosphorus
- Important for women - calcium & vitamin D to prevent osteoporosis
Function of Vitamin E
Antioxidant; protects cell membranes; protects RBCs from breaking down
Function of Vitamin K
Production of blood-clotting protein - prothrombin
ABSORPTION AND STORAGE OF FAT SOLUBLE VITAMINS
Absorbed into lymphatic system
Vitamin A:
- Body can store large amounts
- Vitamin A deficiency: major cause of blindness
- Toxicity: occurs from megadoses
- Food sources: green leafy vegetables, deep yellow and orange fruits and vegetables rich in beta-carotene (carrots)
Vitamin D:
- Produced from cholesterol and ultraviolet light
- Needed for calcium to be absorbed
- Deficiency: blood calcium levels fall - bones lose minerals
Calcium needed for heart to work properly
- Increase: blood calcium levels increase - kidney damage
- Toxicity: occurs when taking supplements
More likely to produce toxic symptoms than others
- Food sources: liver, fatty fish, egg yolks, fortified in milk, cereal, margarine
Vitamin E
- Deficiencies: rare, except in chronic fat malabsorption syndromes
- Can interfere with action of vitamin K in blood clotting by decreasing platelet aggregation
- Large doses potentiate effects blood-thinning drugs
- Food sources: vegetable oils, margarine, salad dressings
Vitamin K
- Quickly depleted when requirements not obtained
- Deficiency: results in hemorrhaging
- Food sources: green leafy vegetables (broccoli), liver, milk, produced by bacteria
WATER-SOLUBLE VITAMINS
- Vitamin C, B-complex
- Absorbed directly into bloodstream
- Move freely through watery environment of blood, within cells
- Excreted in urine when in excess
Consume daily - have to (unlike fat-soluble)
- Release into water when foods cooked, lost if water discarded
Function of Vitamin C
Promotes formation of collagen (protein) which results in building and maintaining strong tissues; promotes iron absorption, promotes wound healing, assists in resisting infection
Function of Thiamine (B2)
Promotes energy metabolism, nervous system functioning
Function of Riboflavin (B2)
Promotes energy metabolism, promotes production of DNA, assists production of proteins
Function of Thiamine (B3)
Promotes energy metabolism, aids tissue protein building, aids oxidation, promotes normal nervous system functioning
Function of Vitamin B6
Amino acid and fatty acid metabolism, promotes blood formation, maintains nervous tissue
Function of Folate (Folic Acid)
Vital for new cell production and transmission of inherited characteristics, prevention neural tube defects, promotes amino acid metabolism, promotes formation of RBC & WBC
Function of Vitamin B12
Activates folate, production of DNA, promotes blood formation, promotes normal functions of cells especially nervous system
Function of Pantothenic Acid
Promotes energy metabolism
Function of Biotin
Involved in energy metabolism, necessary for glycogen formation
ABSORPTION AND STORAGE OF WATER-SOLUBLE VITAMINS
Absorbed directly into the blood stream and excreted in urine
Thiamine
- Deficiency: beriberi - disease of peripheral nerves
Causes fatigue, diarrhea, weight loss, anorexia, paralysis, etc.
- Deficiency seen in alcoholics
- Food sources: whole grained and enriched breads and cereals, liver, dried peas and beans, nuts
Riboflavin
- Deficiency: rare
- Food sources: milk, dairy products, whole grain and enriched breads and cereals, eggs, green leafy vegetables
Niacin
- Deficiency: pellagra - metabolic defect
- Toxicity: liver damage and gout
- Food sources: all protein foods, whole grain and enriched breads and cereals
Vitamin B6
- Deficiency: uncommon
- Toxicity: infrequent
- Food sources: means, fish, poultry, dried peas and beans, fruits, green leafy vegetables, whole grains, nuts
Vitamin B12
- Only water-soluble vitamin not found naturally in plants
- Deficiency: years to develop symptoms - pernicious anemia - injections of Vitamin -B12 = cobalamy given IM z-track
- Food sources: all animal foods, some cereals
Folate
- Deficiency: alcoholics at risk, due to effect of alcohol on GI system
- Infants, adolescents, pregnant women difficulty consuming adequate amounts
Due to growth of new tissue
- Food sources: green leafy vegetables, dried peas and beans, seeds, liver, orange juice, enriched bread and grain products
Pantothenic Acid
- Deficiency: none
- Food sources: meat, fish, poultry, whole grain cereals, dried peas and beans
Biotin
- Deficiency: long term TPN usage - Total Parenteral Nutrition
- Given through IV
- Food sources: eggs, liver, yeast breads, cereals
Vitamin C
- Most famous vitamin - thought to lessen cold symptoms
- Deficiency: scurvy
- Toxicity: diarrhea and GI disturbances, excessive iron absorption
- Food sources: citrus fruits and juices, peppers, broccoli, kiwis, strawberries, tomatoes
MINERALS
- Inorganic elements, originate from earth's crust

- Accounts for 4% of total body weight

- Found in body fluids and tissues
Types of Minerals
- Major Minerals
- Trace Minerals
- both types necessary for life
Major Minerals
- Present in amounts of greater than 5 g
- Needed in relatively large amounts
- Calcium, phosphorus, magnesium
Trace Minerals
- Present in body in amounts less than 5 g
- Only needs small amounts
- Iron, iodine, zinc, selenium, copper, manganese, fluoride, chromium, molybdenum
minerals present in body - potentially harmful
mercury, gold, lead
minerals are not destroyed by
light, air, heat or acids during food preparation
- lost only when food soaked in water
Calcium
- Needed for bone and teeth formation, muscle contraction and relaxation, blood clotting, nerve transmission, promotes normal cardiac rhythm, needs Vitamin D for absorption
- Deficiency: osteoporosis, impaired growth - rickets, tetany diseases
- Toxic effect: kidney stones
- Food sources: milk, dairy products, green leafy vegetables, whole grains
Phosphorus
- Needed for bone and teeth formation, regulates acid base balance, metabolizes energy, provides structure to cell membranes
- Deficiency: rare
- Food sources: animal proteins, soft drinks, additives
Sodium
- Regulates fluid balance, regulates cell permeability, regulates nerve transmission
- Deficiency: results from prolonged vomiting or diarrhea or renal disorders
- Toxic effect: hypertension, cardiovascular disturbance, edema
- Food sources: table salt, milk, processed foods
Potassium
- Maintain fluid balance, acid base balance, transmit nerve impulses, regulate muscle activity, aid in production of proteins, carbohydrate metabolism
- Deficiency: muscle cramps, fluid and electrolyte imbalance, cardiac weakness
- Toxic effect: muscle weakness, mental confusion, cardiac disturbances, cardiac arrest
- Food sources: bananas, orange juice, vegetables, coffee, red meat, milk
Iron
- Aids in formation of hemoglobin - transport oxygen, aids in antibody formation
- Deficiency: anemia
- Toxic effect: hemochromatosis - too much iron in blood
- Food sources: animal sources and plant sources
Iodine
-Component of thyroid hormones
- Deficiency: cretinism, goiter
- Toxic effects: hyperthyroidism, death
- Food sources: table salt (iodized), milk
Zinc
- Needed for tissue growth and wound healing, sexual reproduction and maturation, ensures normal taste and smell, component of DNA and RNA
- Deficiency: poor wound healing, growth retardation
- Toxic effect: renal failure
- Food sources: meat, oysters, eggs, milk, whole grains
Fluoride
- Formation and maintenance of tooth enamel, resistance to dental decay, contributes to bone formation
- Deficiency: dental decay, osteoporosis
- Toxic effect: mottling of teeth - white/yellow patches - too much in water
- Food sources: fluoridated water, seafood, tea
VITAMIN AND MINERAL SUPPLEMENTS
Calcium, Iron, Potassium
Calcium supplement
- Keep doses small < 500 mg
- Spread multiple doses throughout day
- Take w/ food except calcium citrate (empty stomach)
- Do not take w/ iron
- Drink plenty of fluids
Iron supplement
- Do not take w/ milk products
- Take w/ orange juice - promote absorption
- Drink liquid iron through straw - can stain teeth
- Irritating to gastric mucosa
- Stools greenish/black
- Cause constipation - stool softener
Potassium supplement
- Mix liquid w/ water or juice
Never drink liquid potassium on own
- Do not crush or open capsules