exam 4 health assessment promotion nutrition handout

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nutrition
basic human need throughout the life cycle, wellness and illness
•the study of nutrients
•specific biochemical substances used by the body
•vital to life and health
•important component of nursing
a physiological need
according to Maslows hierarchy of needs nutrition is ___
Macronutrients
-supply energy
-build tissue
•*Carbohydrates(CHO)
•*Proteins(PRO)
•*Lipids (Fats)
minerals
vitamins
water
these are the 3 macronutrients
Micronutrients
these regulate body processes
•*Vitamins
•*Minerals
•*Water (H2O)
these are the 3 types of micronutrients
Essential Nutrients
body cannot synthesize or make in sufficient amounts
-must be supplied in diet or as supplement
-amino acids
-body does not store water soluble vitamins
Nonessential Nutrients
synthesized in adequate amounts
-not required for body functioning
cholesterol- body manufactures on own its part of the cell wall and the brain
carbohydrates
4 calories per gram
-sugars and starches
-organic compounds
-plant origin
•lactose only animal source
-most abundant least expensive source of calories
-recommended 50g -100g to prevent ketosis
monosaccharides
-disaccharides
-polysaccharides
these are the 3 types of carbohydrates
Metabolism
-90% digested
-chemical digestion = small intestine
Glucose
sole source of energy to brain
-stored as glycogen
-provide energy, protein sparing, prevent ketosis, increased fecal bulk, decreased intestinal transit time, slow gastric emptying, decrease serum cholesterol level, delay glucose absorption
this is the function of cholesterol
50%
this is the amount of total calories that come from carbohydrates
less
in the U.S. as income increases do people consume more or less carbohydrates?
lactose
this is a combination of glucose and galactose and is a carbohydrate
90 %
this is the percent of African Americans who are lactose intolerant
50%
this is the percent of Hispanics who are lactose intolerant
Co2 and H20
when carbohydrates are burned or oxidized this is their byproduct
protein
gives off 4 calories per gram
-vital component of living cell
-made of amino acids
-include nitrogen
-9 essential amino acids
-classification
•Complete
•incomplete
•Complimentary
-catabolism
-anabolism
Metabolism of proteins
neutral
-positive
-negative
Nitrogen Balance of proteins are
tissue growth and repair
-component of ......
•bones, muscles, tendons, etc.
•hormones, enzymes, plasma proteins, neurotransmitters
-regulates acid-base,fluidbalance
-Detoxifies, forms antibodies, transports substances through the blood, provides energy when CHO intake is inadequate
proteins functions
10 % to 20 % total
the amount of protein recommended
homocysteine
Elevated levels associated with inflammation and peripheral, cerebrovascularand coronary artery disease.
complete proteins
these are high quality proteins such as eggs, meats
incomplete proteins
these are proteins that are low quality deficient in one or more amino acid ( plants)
complementary
mix different protein so the food will provide high quality protein such as beans and rice, cereal and milk, cheese sandwich, corn tortillas
catabolism
this is when you are breaking down proteins
anabolism
this is when you are protein building
making and building more cells
nitrogen balance
constant state of flush
neutral nigtrogen balance
when you are taking in as much nitrogen as you are putting out.
positive nitrogen balance
is when your intake exceeds excretion ( healing, pregnant, lactating)
negative nitrogen balance
more nitrogen excreted than consumed ( surgery, illness, trauma, burns, increased fever)
calorie malnutrition
hospital patients are at risk for this
increase plant protein and decrease animal protein
to reduce saturated fats you should do this with your diet
lipids
these are also known as fast •Insoluble in water & blood
-simple
-compound
-Triglycerides (95% of lipids in diet)
by themselves they are not bad
saturated lipids
cannot hold anymore hydrogen (solid at room temperature)
unsaturated lipids
have the potential to hold more hydrogen (liquid at room temperature)
lipids
these are the most concentrated source of energy delivering 9 calories per gram
HDL
•"good" cholesterol ( lipids)
•from tissues to liver for
catabolism and excretion
•increased ratio of HDL's reduces total cholesterol = reduced risk.
LDL
•"bad" cholesterol ( lipid)
•carries cholesterol to the cells for deposit.
•Increased ratio of LDL's = increased risk
deposited into cells
Increase polyunsaturated intak
to reduce cholesterol you should do this
linoleic acids
this is an essential fatty acid
-of 100 grams eaten, only 3gms excreted
metabolically how do lipids work
monosacharides
olive oil, canola oil
cholesterol
you want this to be below 200
LDL
you want this to be 100 or less
HDL
60 or above
triglycerides
these should be less than 150
•vit. C & B compllex
•need daily supply (not stored)
•not stored
these are water soluble vitamins
A,D,K,&E
•stored
•can become toxic
these are fat soluble vitamins
-Inorganic
-provide structure
-regulate cellular function
these are the characteristics of minerals
>100mg/day
the body needs how much macrominerals
<100mg/day
the body needs how much microminerals
Major body constituent
•50%-60% of adult weight
•2/3 of body H2O = Intracellular
•More vital to life than food
•Functions
•Sources
•Avg intake = 1500ml-3000ml/day
total output is the same
the characteristics of Water
nutritional needs
-rapid period of growth
-breast fed
-bottle fed
-solid foods
-pancreatic amylase
can become water toxic which will affect the brain
avoid honey because infant can get botulism which gives off toxins and paralysis the infant
factors effecting nutrition development in infants -(birth to 1yr)
-growth
-self-feeding
-protein, calcium & phosphorous needed
-foods to avoid
-food attitudes develop
•verbalize likes and dislikes
* they loose their primary teeth and therefore need calcium
factors effecting nutrition development in Toddlers & Preschoolers 1-5
25
boys increase their muscle mass and therefore need more food until around age ___ stop increasing muscle mass
18
girls continue to grow until age ___
appetite is bigger
-dental health (calcium)
-advertising
-nutrient needs
factors effecting nutrition development in School Age -(6 to 12)
-nutrient needs
•boys
•girls
-Calcium
-Teenage pregnancy
-Body Image
factors effecting nutrition development in adolescent
30
you should continue to increase your calcium levels up to this age to avoid developing osteoporosis
growth stops
BMR slows down around age 25/30
increase your activity and decrease calories at this time
factors effecting nutrition development in adults
calorie needs decrease
BMR decreases
develop health issues (chronic diseases)
factors effecting nutrition development in older adults > 65
gender
personal preferences
lifestyle
ethnicity and culture
beliefs about food
religious practices
health status
fever - increase metabolism
chronic disorders
ETOH
advertising
factors effecting nutrition
ETOH ethanol alcohol
this is a malnurished state that impacts neurosystem,heart, liver, GI
elderly
fixed income
psychosocial - pier influnece, psychiatric drugs
socioeconomic factors that effect nutrition
-Ht/wt
-BMI (body mass index)
-Skin fold
-MAC (mid-arm circumference)
Anthropometric data taken during nutritional assessment
hemoglobin -Hgb-(12-18g/dL)
-hematocrit Hct-(40-50%)
-serum albumin -(3.3-5g/dL)
-transferrin
-total lymphocyte -( >1800)
-electrolytes•K+, Na+, Cl-, CO2
-BUN blood, urine, nitrogen (17-18mg/dL)
-creatinine-(0.4-1.5mg/dL)
-glucose
-UA
•sugar/acetone -body not metabolizing sugar. acetone shows us its breaking down fat
Biochemical data taken during nutritional assessment
nursing history
physical exam ( skin, hair, nails, mucous membranes, activity level)
Clinical data taken during a nutritional assessment
24 hr food recall
-food frequency record
-food diary
-likes/dislikes
-elimination patterns
-nutritional screening to
Dietary data during a nutritional assessment
mypyramid
this focuses on wellness not illness. tool to teaching
BMI
this includes waste circumfrance relationship and chronic disease such as heart disease.
Eat a variety
-Balance food and activity to maintain or improve weight
-choose plenty of grain products, vegetables and fruits
-Follow RDA's
Guidelines for health promotion
decreased fat, saturated fats and cholesterol
-moderate in sugars
-moderate in salt & Na+
•If you drink ETOH, drink in moderation
Choose a diet in:
Tailor to client
-simple
-include family
-avoid foods not tolerated
-Alert physician if problem
-offer support and encouragement
-acknowledge success
-do notoverwhelm
-evaluate
Client instruction
Hospitalized client
Generally have complex problem (multisystems)
-Requires collaboration with
physician, dietician, speech therapy (dysphagia)
-Monitor nutritional status (asses skin)
-Provide appropriate diet, enteral or parenteral feedings
internal feeding in stomach
this is the preferred feeding technique for people who are unable to feed themselves.want it close to normal. parietal you place an IV into the veins.
nasogastric
with a nasogastric tube you measure from ear down to zyphoid process. get past epiglottis have them swallow. Inject 10 ml of air and listen to the stomach. aspirate to see if PH reflects stomach PH 0-4 . Low suction 82-120 usually around 90. too much suction the stomach collapses
salum sump
this has a vent allows air to go into stomach so it wont collapse.
Levine tubes
for feeding. must do a chest x-ray to make sure its properly placed.
nasogastric feeding
check for residual. if feeding someone put stomach contents back in important electrolytes in stomach content. tube feeding person at least 30 degree continuous feeding.
greater than 100 cc or 1/2 stomach content
if this occurs when tube feeding you will not give next bolus feeding.
take a deep breath and hold it
when taking out a nasogastric tube this is what you tell the client to do.
24 hours
this is the maximum amount of time that should pass before you change out a nasogastric tube.
intravenous liquids
these liquids are usually clear other than lipids which look like milk.
Check with pharmacist for liquid form
•Check to see if medication can be crushed
•Crush a tablet into a fine powder and dissolve in at least 30mls warm water
•Open capsules and mix with water only with pharmacists advice
•Do not administer whole or undissolved medications
•Assess tube placement
•Aspirate stomach contents and measure residual volume (should be hooked up to suction so no content in stomach)
•Remove the plunger from the syringe
•Connect syringe to a pinched or kinked tube
•Put 15-30ml (5 -10ml for children of water into the syringe barrel to flush the tube
•Pour liquid or undissolved medication into the syringe barrel and allow to flow by gravity into the enteraltube
medication administration via nasogastric/ gastrostomy tube
Administer each medication separately and flush in between
•After administration of all medications, flush again
•If the tube is connected to suction, disconnect the suction and clamp the tube for a minimum of 30 mins. To enhance absorption.
administering medication by nasogastric
Need physicians order
•Xrayfor placement before beginning feeding via new tube placement
•Always check residuals
•Keep HOB (head of bed) elevated 30 degrees providing enteralfeeding
•Assess placement and document every shift and prior to administering meds/feedings via tube
•Change feeding bags/containers and tubing per agency policy
•Provide free water
Nutritional
Safety concerns for feeding/med administration via NG or gastrostomytube
breaks it down
hydrochloric acid does this to the skin
develop diarrhea
when giving a tube feeding and its hypertonic this is what happens to the body
Maintain or restore optimal nutritional status
•Prevent complications associated with malnutrition
•Prevent aspiration
•Promote healthy nutritional practices
•Maintain optimum body weight
•Promote fluid and electrolyte balance
•Promote healing
Nutritional outcomes