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

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nutrition you are what you eat
Nutrition – You Are What You Eat
  • Nutrition – Has been defined as the food you eat and how your body uses it.
  • Nutrients – are chemical substances supplied by food that the body needs for growth , maintenance and repair
  • Macronutrients – are carbohydrates, fats, and proteins
  • CHO, fats are well known as fuel foods – but protein is sometimes forgotten
  • CHO – 4Kcal/gm
  • FAT – 0 Kcal/gm
  • Protein – 4 Kcal/gm
diet illness
Diet & Illness
  • Some of out nation’s top leading causes of death have been associated with diet:
  • 1. Coronary heart disease
  • 2. Certain types of cancer
  • 3. Stroke
  • 4. Diabetes
  • 5. Atherosclerosis
nutrition purpose
Nutrition - Purpose
  • 1. Provide energy for body processes & movement
  • 2. Provide structural material for body tissue
  • 3. Regulating body processes
photosynthesis
Photosynthesis
  • Plants with green leaves trap the radiant energy of sun & through this process, store it as chemical energy in CHO
  • CO2 = H2O + Chlorophyll = CHO ---- either as a starch or sugar
  • Plants – Such as:
    • potatoes, wheat, rice = starch
    • peas, bananas, cherries, or beets = sugar
  • CHO (Carbohydrates) are most economical form of energy, readily accessible foods, the energy used by the brain
simple vs complex carbohydrates
Simple vs Complex Carbohydrates
  • Simple:
  • Monosacchrides:
  • Glucose, Fructose, Galoctose
  • Foods: grapes, oranges, dates, honey, corn syrup
  • Type CHO that is absorbed from intestinal tract
simple cho
Simple CHO
  • Disacchrides : Double sugar
  • Succose, maltose, lactose
  • W & B Sugar, molasses, honey, sweet potatoes, pineapples, carrots
complex cho
Complex CHO
  • Polysaccharides -
  • Starches
  • Fiber
complex polysaccharides
Complex - Polysaccharides
  • Starches – Large molecule of glucose
  • Requires longer to digest
  • Glucose available slower
  • Ex: Cereal grains, corn, peas, potatoes, squash, legumes
  • Starch increases with maturity
fiber
Fiber
  • Cellulose
  • Absorbs water to provide bulk or roughage in diet
  • Bulk stimulates peristalsis
  • Cellulose is undigested
dietary fiber 20 35 g day
Dietary Fiber 20-35 g/day
  • Soluble:
  • Able to dissolve in H2O
  • Beans, oatmeal, barley, broccoli, citrus fruits
  • Regulate blood glucose level
  • Weight loss
  • Lowers cholesterol
dietary fiber
Dietary Fiber
  • Insoluble:
  • Incapable of being dissolved
  • Fruits and veg. skins, nuts, popcorn
  • Promote bowel regularity
  • Decreases risk diverticular diseases, cancer
circulating blood glucose
Circulating Blood Glucose
  • 40mg/dl - 80 -- 120 - 160 - 180 --- 500
  • Hypoglycemia Glucose Exceeds
  • Body secretes Renal threshold
  • Hormones i.e. Glucosuria
  • Epinephrine, Insulin is secreted

Growth from Beta cells of

*Glucagon Pancreas to< BGL

circulating blood glucose con t
Circulating Blood Glucose (con’t)
  • *Glucagon (Job is to increase BGL)
  • Is secreted by alpha cells of pancreas
  • Stimulates the breakdown of glycogen & release of glucose by the liver > increases blood sugar levels
  • That’s why if you are hungry @ 10-11am you will be able to wait until 1 pm or so to eat
circulating blood glucose con t1
Circulating Blood Glucose (con’t)
  • Glycogen:
  • Is a polysaccharide
  • Is stored in liver & muscle tissue (called animal starch)
  • Is a string of glucose.
  • 50-75 gm of glucose is stored in the liver as “hepatic glycogen”
  • An adult male has 300 gm stored in the liver & muscles
  • An important link in energy metabolism:
  • Helps sustain normal blood sugar levels during fasting periods such as sleep hours
  • Provides immediate fuel for muscle action especially athletic activity.
digestion of cho
Digestion of CHO
  • Mouth -> chewing food particles ->mixes with Saliva (Salivary Amylase) > changing dextrins & maltose
  • Stomach – Mixing continues > Thicker > Chyme
  • Small Intestines – With aide of:
  • Pancreatic Amylase & Intestinal Secretions > conversion from complex to simple sugars
  • From small intestines ->
  • 1. portal circulation to liver to be converted to glucose & then glycogen & Stored
  • 2. To blood stream to all cells for Energy
  • 3. Or stored as Fat
cho signs symptoms of inadequate cho intake
CHO: Signs & Symptoms of Inadequate CHO Intake
  • 1. Fatigue
  • 2. Dehydration
  • 3. Energy Loss
  • CHO are stored for around 24 hours
  • *If CHO are lacking then:
  • 1. Protein catabolism begins only after a few hours rather than using protein for healing
  • 2. Fat tissue is broken down with release of fatty acids, glycerol & ketone bodies which means fats burn incompletely & acidosis occurs. *Glucose is required for complete oxidation of fats.
cho signs symptoms of inadequate cho intake con t
CHO: Signs & Symptoms of Inadequate CHO Intake (con’t)
  • As long as glucose is present, ketones are quickly metabolized by muscle tissue so that ketone levels of the blood remain unchanged.
  • Pts. with Ketoacidosis have excessive ketone bodies in the blood. They exhibit hyperventilation, loss of Na, K+, Cl- and H2O form the body.
  • Excessive glucose is converted to glycogen until this limited glycogen storage capacity is filled (50-75gm) simultaneously glucose is also converted into fats & stored as adipose tissue.
slide19
Normal Blood Glucose Level:80 – 120 mg/dlFactors that affect how much CHO are available for the body to use:
  • 1. State of mucous membrane of GI tract:
    • i.e.: intestinal disease or hypermotility (Diarrhea)
    • This limits or alters contact with CHO to intestinal wall for absorption
  • 2. Hormones:
    • i.e.: Insulin, Glucagon (from pancreas) & epinephrine (from adrenal glands)
  • 3. Vitamins: especially “B” complex are involved in the metabolism of CHO
    • B1 – Thiamin, B2 – Riboflavin, B3 – Niacin
    • *** Remember TRN 123 Temporary Registered Nurse
slide20
CHO are Protein sparing:
    • If CHO are present in adequate amounts you don’t use protein for energy.
  • Need 100g/day to prevent this
  • CHO’s prevent formation of ketones (Ketoacidosis):
    • if CHO decreased (starvation, diabetes)
    • excess fat is oxidized and therefore increases ketones
energy from cho is in the form of
Energy from CHO is in the form of:
  • Heat
  • Muscle contraction
  • Synthesis of essential compounds
  • Conduction of nerve impulses
health problems cho s
Health Problems & CHO’s
  • Dental caries
  • Obesity
  • Hypoglycemia/ Hyperglycemia
  • Alcohol blocks glucose production by the liver
lipids fat
Lipids -- Fat
  • Classified According to three Criteria:
  • 1. Whether the fat is emulsified or nonemulsified
  • 2. Visible or invisible
  • 3. Simple or Compound
lipids fat con t
Lipids – Fat (con’t)
  • The term Emulsion is applied to a liquid dispersed in another liquid with which it does not usually mix.
  • i.e.: Oil and Vinegar do not mix
  • Fat is insoluble in H2O
  • A means of transporting fat thru the water based blood is a problem.
  • So the body must emulsify dietary fat.
  • This occurs in the small intestine thru the action of bile salts (from liver to GB)
visible vs invisible
Visible vs. Invisible
  • 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
simple vs complex
Simple vs Complex
  • Lipids in foods and in the human body fall into 3 classes:
  • 1. Triglycerides (simple) – 95%
  • 2. Phospholipids – ex. Lecithin
  • 3. Steriods – ex. Cholesterol
  • Blood lipids, cholesterol, fats & oils all contribute to health and detract from it.
fats provide
Fats Provide:
  • 1. Energy – for now & stored fat for later energy
  • 2. Insulation – Maintaining body temp & padding (protecting organs)
  • 3. Cell membrane integrity
  • 4. Nerve impulse transmission
  • 5. Carries fat soluble vitamins (ADEK)
  • Taste (satiety) – Adds texture & flavor to foods
usefulness of fats
Usefulness of Fats
  • In Foods:
    • Makes foods taste better
    • Taste, smell, feel full
    • Provide essential fatty acids
    • Provide energy
    • Carry fat soluble vitamins
  • In Body:
    • Insulation
    • Padding
    • Energy
    • Cell membrane material
fatty acids
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
monounsaturated fatty acid
Monounsaturated Fatty Acid
  • Usually 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
polyunsaturated fatty acids
Polyunsaturated Fatty Acids
  • Plant Origin
  • Liquid at Room Temp.
  • Foods: Veg. Oils
  • Sunflower oils
  • Some margarines
  • French Dsg.
  • Walnuts
trans fatty acids
Trans-Fatty Acids
  • Have implications for the body’s health
  • 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
  • Are found in fast foods, chips, baked goods, & other commercially prepared foods
  • High in fats can contain up to 50% trans-fatty acids
chemical digestion fat begins
Chemical Digestion Fat Begins
  • Mouth -> via chewing -> smaller parts & warms food
  • Stomach -> Fats emulsified due to Gastric lipase & peristalsis
  • Small Intestine ->
    • Bile Salts: Fat in duodenum -> releases of cholecystokinin > causes GB to contract > releases bile
      • Bile: 20-60 ml held in Gallbladder, produced in liver
    • Enzymes: pancreatic lipase & enteric lipase
  • End Products: Monoglycerides, Fatty acids, Glycerol
blood lipid profile
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
the good bad the ugly cholesterol
The Good , Bad & The Ugly - Cholesterol
  • Important in structure of brain & nerve cells
  • Nonessential nutrient
  • Endogenous supply
  • 1000mg/day
  • Take in more > Body makes less
  • Major contributor of plaque
  • <200 mg/dl
  • Keep intake <300mg/day
cholesterol food sources
Cholesterol – Food Sources
  • Egg Yolk
  • Organ meats (especially liver & kidney)
  • Cream
  • Butter
  • Ice Cream
  • Cheese* ( The lighter in color the lower the amount of cholesterol)
  • Remember – if it had or has a heart beat, it has cholesterol
what about fat substitutes
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
proteins the most expensive nutrient
Proteins – The Most Expensive Nutrient
  • Proteins are the building blocks of blood and bone & all other tissues. They are the structural part of every cell.
  • They are made up of smaller building blocks called amino acids.
  • Found in scar tissue, hair growth, blood albumin, Hemoglobin
more on proteins
More on Proteins
  • Chemical elements – C, H, O2 & Nitrogen
  • Linked together by peptide bonds
  • 50,000 different proteins
  • 24 Amino Acids
  • Change the number or arrangement you change the Amino Acid
  • Essential vs Nonessential
4 major functions in body
4 Major Functions in Body
  • 1. Maintenance of Growth
  • 2. Regulation of Body Process
  • 3. Development of Immunity
  • 4. Energy
amino acids
Amino Acids
  • Essential:
  • Means they cannot be manufactured by body & must be obtained from food
  • 9
  • All 9 must be available simultaneously & in sufficient quantities for synthesis of body proteins
  • Nonessential:
  • Can be synthesized by body
  • Often derived from other amino acids
complete vs incomplete protein foods
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
  • Examples:
  • Corn & peas
  • Spaghetti Noodles & cheese
  • Milk & cereal
  • Rice with pork
  • Noodles with tuna
keeping a positive nitrogen balance
Keeping a Positive Nitrogen Balance
  • Protein Balance: The body’s tissue proteins are constantly being broken down into amino acids, a process called catabolism & the resynthesized into tissue proteins as needed , a process called anabolism.
  • To maintain Nitrogen balance, the Nitrogen containing element of the amino acids can be removed by a process called deamination – converting to ammonia (NH3) & the Nitrogen is excreted as urea in the urine.
keeping a positive nitrogen balance con t
Keeping a Positive Nitrogen Balance (con’t)
  • A positive nitrogen balance exists when nitrogen intake exceeds output, that is when protein anabolism exceeds protein catabolism.
  • A negative nitrogen balance exists when nitrogen output exceeds intake. This state usually occurs when a person does not consume adequate essential amino acids & or calories, is immobilized, or is exposed to unusual stress as a result of trauma. To prevent this a person must ingest at least 20-30 gms of protein each day.
protein metabolism
Protein Metabolism
  • Mouth -> chopping into smaller parts
  • Stomach -> Chemical digestion begins with help of: Pepsin, HCL, & Rennin
  • Small Intestines -> Digestion is completed here
  • Pancreatic Secretions: Intestinal Secretions:
  • Ex: Tryosin Ex: Ainopeptidase
  • Chymotrypsin Dipeptidase
  • Carboxypeptidese
  • Absorption occurs thru lining of small intestines with help of Na
  • End Products: H2O – Urea – CO2 > Liver
lab values protein
Lab Values - Protein
  • Albumin accounts for >50% of total protein & therefore reflects the protein status of blood & organs.
  • Albumin levels: 3.5-5 g/dl or 35-45 gms
  • Albumin levels increase & decrease slowly therefore when decrease serum albumin is seen associated with malnutrition, it reflects prolonged protein depletion.
  • Other conditions that show decreased albumin levels are, liver & kidney disease, AIDS, Ca, & burns.
daily allowances of protein
Daily Allowances of Protein
  • Based on age & desired weight
  • Newborn: 2.2 gm/kg
  • 7-10: 1.2 gm/kg
  • Adolescent: 1 gm/kg
  • Adult: 0.8 gm/kg
  • A man weighing 154 lbs. = 56 gm of daily protein
  • Food examples:
  • 7 inch carrot = 1 gm protein
  • 1 small raw tomato = 1 gm of protein
  • Egg = 6 gm of protein
  • Meat = 7 gm/ounce
  • Milk = 9 gm/cup
water h20
Water – H20
  • Must be consumed often & in greater quantities
  • Solvent in which chemical reactions occur
  • Medium for transporting substances. Ex: Blood, Lymph, Waste
  • Provides lubrication. Ex: Synovial fluid & mucous
  • Contributes turgor to cells
  • Regulates body temperature via Evaporation
  • Which food are high?
micronutrients vitamins
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 contain Nitrogen
    • Very little stored therefore few toxic levels occur
minerals
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!
minerals con t
Minerals (con’t)
  • Minerals are found in organic compounds or inorganic compounds & as free ions.
  • Upon oxidation, minerals leave an ash, which can be acid or alkaline.
  • Ca & P make up 80% of all mineral elements in the body.
  • There are 2 categories:
  • Macrominerals: These are minerals people require daily in amounts> 100 mg. Ex: Ca, P, Na, K, Mg, Cl
  • Microminerals: are those that people require daily in amounts < 100 mg. Ex: Fe, Zn, I, F.
nutrition1
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
consider the following when assessing nutritional status
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
caloric requirements vary r t
Caloric Requirements Vary R/T
  • Age & Growth: Growth > calorie
  • Sex: Men have ^ BMR due to muscles, Pregnancy ^
  • Climate: Colder > BMR
  • Health/Illness: ^ Temp. = ^ BMR, Malnutrition = Decreased BMR
  • Sleep
  • Type food consumed
  • Activity - ^ = ^BMR
factors affecting eating
Factors Affecting Eating
  • Culture
  • Religion
  • Socioconomic
  • Personal Preference – Childhood
  • Emotions
  • Health
religious considerations
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)
religious considerations con t
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
do you know your numbers
Do You Know Your Numbers?
  • Calculate BMI:
    • Take Wt x 704 = A
    • Take Ht inches x Ht inches = B
    • A divided by B = BMI
  • Ideal -> 20 – 25:
    • Lowest risk for obese diseases (CV, Diabetes, & Stroke)
  • 25-30: Overweight
  • > 30: Obese (Increased risk for the “3”)
  • How about IBW
nursing interventions to encourage nutrient intake
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
food pyramid guide
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.
factors to consider when planning a meal
Factors to Consider When Planning a Meal
  • Include all of the food groups
  • Variety: Color, Texture, Flavor, Shape, Satiety, *Don’t overemphasis one food group
  • Sociologic & personal preference
  • Time & Energy
  • Appearance
  • Economical fuel usage
  • Food cost
common therapeutic diets
Common Therapeutic Diets
  • Regular
  • Liquids: Full vs Clear
  • Soft
  • Low Residue
  • Low Fat
  • Low Carbohydrate
  • Diabetic
calculating i o do you know your sources
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
calculating i o do you know your sources con t
Calculating I & O:Do You Know Your Sources? (con’t)
  • Output:
    • Urinary
    • Vomitus
    • Liquid Feces
    • Tube Drainage
    • Wound Drainage
    • Fistula Drainage
    • Rapid Respirations
    • Diaphorsis
parenteral therapy
Parenteral Therapy
  • Intake
  • Equipment:
  • IV Bag
  • Drip Chamber
  • Tubing
  • Roller Clamp
  • *Dial-a-Flow
  • *Infusion Pump
ways to control volume of fluid to patients
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
complications from iv therapy
Complications from IV Therapy
  • Hematoma: Collection of blood
  • Phlebitis: Inflammation of vein
  • Infiltration: Seepage of fluid into the tissue rather than vein
  • Prevention:
  • Frequent assessment
  • Antiseptic ointment at site
  • Changing lines per hospital protocol ( q 72 hours)
insertion of a nasogastric tube for suction or feeding
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?
the tube is in now what do i do
The Tube is in, Now what do I do?
  • 1. Check for placement, but how?
    • A. Instill 10cc air while you listen.
    • B. Aspirate stomach contents & check the pH
    • C. Chest X-ray if possible.
  • 2. Be sure they can speak.
  • 3. Secure with tape to nose & provide comfort measures.
  • 4. Connect to feeding or suction.
ph of secretions
pH of Secretions
  • Yellow-Green: is pH of 1-4 = Acidic in Gastric Secretions
  • Golden Yellow: is pH of 6.5 = Intestinal Secretions
  • Color change toward blue: Is pH 7.0-8.0 = Lungs and a more alkaline pH