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Nutrition – Chapter 30

Nutrition – Chapter 30. Learning objectives. Identify nutrition and fluid intake and output requirements across the lifespan Describe nutrition and fluid balance Identify types of nutrients Explain roles of nutrients in the body Identify food sources for nutrients. Learning objectives.

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Nutrition – Chapter 30

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  1. Nutrition – Chapter 30

  2. Learning objectives • Identify nutrition and fluid intake and output requirements across the lifespan • Describe nutrition and fluid balance • Identify types of nutrients • Explain roles of nutrients in the body • Identify food sources for nutrients

  3. Learning objectives • Explain types of therapeutic diets • Explain the relationship of prescribed diet to nutritional/fluid balance • Identify equipment for measuring nutrition and fluid intake and output • Calculate nutritional/fluid intake and output

  4. Learning objectives • Define enteral feedings • Explain the procedure for initiating enteral feedings and equipment used

  5. Nutrition – You Are What You Eat • Nutrition – the food you eat and how your body uses it • Nutrients – chemical substances supplied by food that the body needs for growth, maintenance and repair • Macronutrients – carbohydrates, fats, and proteins

  6. Nutrition • Nutritional status is determined: • By what & how much the individual eats • By his or her’s body ability to use nutrients • By the state of the person as a result of the intake of nutrients

  7. Factors Affecting Eating • Culture • Religion • Socioeconomic • Personal Preference Childhood • Emotions • Health

  8. Diet & Illness • Some of our nation’s top leading causes of death have been associated with diet: • Coronary heart disease • Certain types of cancer • Stroke • Diabetes • Atherosclerosis

  9. Nutrition - Purpose • 1. Provide energy for body processes & movement • 2. Provide structural material for body tissue • 3. Regulating body processes

  10. Nutrients • CHO, fats are well known as fuel foods – but protein is sometimes forgotten • CHO – 4Kcal/gm • FAT – 0 Kcal/gm • Protein – 4 Kcal/gm

  11. Simple vs Complex Carbohydrates • Simple: • Monosaccharides: • Glucose, fructose, galactose

  12. Simple CHO • Disaccharides : Double sugar • Sucrose, maltose, lactose • W & B Sugar, molasses, honey, sweet potatoes, pineapples, carrots

  13. Complex CHO • Polysaccharides - • Starches • Fiber

  14. Complex - Polysaccharides • Starches – Large molecule of glucose • Requires longer to digest • Glucose available slower • Ex: Cereal grains, corn, peas, potatoes, squash, legumes

  15. Lipids -- Fat • Classified According to three Criteria: • Whether the fat is emulsified or nonemulsified • Visible or invisible • Simple or Compound

  16. Visible vs. Invisible Fats • Visible Fat: 40% Invisible Fat: • Easily seen Hidden in foods on meat Egg yolk • Oil Baked goods • Butter Snacks • Emulsified milk • Cheese • Olives • Nuts • Avocados

  17. Fats Provide: • Energy • Insulation • Cell membrane integrity • Nerve impulse transmission • Carries fat soluble vitamins (ADEK) • Taste (satiety)

  18. Fatty Acids • Saturated: Unsaturated: • One whose Has at least one structure is unfilled H+ spot completely Monounsaturated filled with all vs H+ it can hold Polyunsaturated • Heavier, more The more unsat. dense,more solid the more liquid • Requires higher at room temp. Temp. to melt

  19. Monounsaturated Fatty Acid • Usually of Plant origin • Liquid at Room Temp • Can Become saturated if a chemical change occurs • Foods: Peanuts, Peanut oil, Olives & Olive oil, Almonds, Pecans, Canola oil

  20. Polyunsaturated Fatty Acids • Plant Origin • Liquid at Room Temp. • Foods: Vegetable Oils, Sunflower oils, some margarines, french dressing, walnuts

  21. Trans-Fatty Acids • Not currently mentioned on food labels • Carry a risk similar to saturated fats • Elevated blood cholesterol & thus raise the risk of heart disease & heart attack

  22. Blood Lipid Profile • Triglycerides: <100 mg/dl desired • Cholesterol: <200mg/dl • 200-239 Borderline • CVD. > 240 ^ risk • Lipoproteins: • HDL – High density – good • 29-77 mg/dl • Carry cholesterol away from cell • LDL Low density – bad • 62-185 mg/dl • Carry cholesterol to cell

  23. Cholesterol – Food Sources • Egg Yolk • Organ meats (especially liver & kidney) • Cream • Butter • Ice Cream • Cheese

  24. What about Fat Substitutes? • “O’lean”, Olestra • O’lestra: is indigestible therefore the body has no way to take it apart • Problems: causes digestive distress & nutrient losses • i.e.: gas, diarrhea, cramping, strong “urge to go” • Oil can leak thru feces & leak from the anus • May interfere with absorption of fat soluble vitamins

  25. Proteins – The Most Expensive Nutrient • Building blocks are amino acids • Structural part of every cell

  26. Four major functions of protein in the body • Maintenance of Growth • Regulation of Body Process • Development of Immunity • Energy

  27. Amino Acids • Essential: (9) • Means they cannot be manufactured by body & must be obtained from food • Nonessential: • Can be synthesized by body • Often derived from other amino acids

  28. Complete vs Incomplete Protein Foods • Complete: • Have all 9 Essential Amino Acids • Examples: Meat, Eggs, & Milk • Incomplete: • Lack some Amino Acids • Some foods mixed together = a complete protein food

  29. Dietary Fiber 20-35 g/day • Soluble: • Able to dissolve in H2O • Beans, oatmeal, barley, broccoli, citrus fruits • Regulate blood glucose level

  30. Dietary Fiber • Insoluble: • Incapable of being dissolved • Fruits and vegetable skins, nuts, popcorn • Promote bowel regularity

  31. Water – H20 • Must be consumed often & in greater quantities • Solvent in which chemical reactions occur • Medium for transporting substances. • Provides lubrication • Contributes turgor to cells • Regulates body temperature

  32. Micronutrients - Vitamins • Fat Soluble: A, D, E, K • Stored in the body • Stable in heat • No nitrogen • Require bile for absorption • Soluble in fats • Water Soluble: C, B Complex • Soluble in water • May be affected by cooking methods • B Complex contains Nitrogen • Very little stored therefore few toxic levels occur

  33. Minerals • Minerals, or elements: are inorganic substances • Required in small amounts • Cannot be synthesized in the body, must be obtained from food • Some are important constituents of bones (Ca), others are required to activate specific enzymes involved in chemical reactions, to maintain acid-base balance (Mg, P, Na, Cl) & water balance (K, Cl) & muscle functions (Mg, K, Na, Ca). • Approx. 3-6% of the body weight is made up of minerals (ash). Minerals should be supplied daily because they are excreted every day by the kidneys, bowel, & skin. • Minerals are stored!

  34. Minerals (con’t) • Minerals are found in organic compounds or inorganic compounds & as free ions.

  35. Consider the following when assessing Nutritional Status • 1. Anthropometric measurements: Ht, Wt, Skin folds, Arm Circumference • 2. Dietary History • 3. Clinical signs of poor nutrition • 4. Energy Level • 5. Factors Affecting

  36. Religious Considerations • Jewish: • Don’t mix meat & dairy products at the same meal • Prohibited Foods: • All products obtained from pigs: i.e.: pork, bacon, ham, animal shortening, marshmallows (gelatin)

  37. Religious Considerations (con’t) • Catholic: • Abstain from eating meat & from eating between meals on Ash Wednesday & Good Friday • Observe periods of fasting • Seven-Day Adventist: • Prohibited Foods: Pork products & shellfish • Alcoholic beverages • Church of Jesus Christ of the Latter-Day Saints (Morman): • Alcoholic beverages • Christian: • Alcoholic beverages

  38. Nursing Interventions to Encourage Nutrient Intake • Assess situation: Foods, History, Health Issues, etc. • Provide Foods they like • Consult with Registered Dietician • Environmental Changes • Consider Medical Treatment: Meds around meals

  39. Food Pyramid Guide • MILK Products: 2-3 *Serving is 1 cup (8oz) • FRUIT: 2-4 • VEGETABLES: 3-5 • BREADS & CEREALS: 6-11 • MEAT/FISH: 2-3 * Serving is 2-3 oz.

  40. Factors to Consider When Planning a Meal • Include all of the food groups • Use variety: Color, Texture, Flavor, Shape, Satiety, • Sociologic & personal preference • Time & Energy • Appearance • Economical fuel usage • Food cost

  41. Common Therapeutic Diets • Regular • Liquids: Full vs Clear • Soft • Low Residue • Low Fat • Low Carbohydrate • Diabetic • Low sodium • High fiber

  42. Calculating I & O:Do You Know Your Sources? • Intake: • Oral Fluids: H2O, Coke, Tea • Ice chips • Food (Liquid @ room temperature) • Tube Feedings • IV Fluids • Irrigants • Blood

  43. Calculating I & O:Do You Know Your Sources? (con’t) • Output: • Urinary • Vomitus • Liquid Feces • Tube Drainage • Wound Drainage • Fistula Drainage • Rapid Respirations • Diaphoresis

  44. Parenteral Therapy • Intake • Equipment: • IV Bag • Drip Chamber • Tubing • Roller Clamp • *Dial-a-Flow • *Infusion Pump

  45. Ways to control Volume of Fluid to Patients • IV Pumps • Solusets • Dial-a-Flow • Setting the correct rate on the pump • Counting the number of drops in the drip chamber • Assessing the patient frequently

  46. Complications from IV Therapy • Hematoma • Phlebitis

  47. IV Care • Frequent assessment • Antiseptic ointment at site • Changing lines per hospital protocol (q 72 hours)

  48. Insertion of a Nasogastric Tube for Suction or Feeding • Have you collected ALL your supplies? • What position do you need to place your patient? High Fowlers • Which nostril should I use? • How far do I insert the tube? Measure • During insertion: • What do I tell my patient. • What should they be doing? • What technique should I be doing? • Do they stay in the same position the whole time?

  49. Bolus vs Continuous enteral feeding

  50. Measurement for NG tube

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