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Nutrition

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Susan Alfert

on 13 September 2015

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Transcript of Nutrition

NUTRITION
Digestion
Digestion begins in the mouth and ends in the small and large intestines
Absorption: The intestine is the primary area of absorption.
Metabolism and storage of nutrients: Consists of anabolic and catabolic reactions.
Elimination: Chyme is moved through peristalsis and is changed into feces.
Background
Food security is critical for all members of a household.
Food holds symbolic meaning.
Medical nutrition therapy uses nutrition therapy and counseling to manage diseases, such as Type I diabetes; hypertension; and inflammatory bowel disease, with enteral nutrition (EN) or parenteral nutrition (PN).
Nutritional Guidelines
Healthy People 2020 is an initiative with the overall goals of promoting health and reducing chronic disease. Go to http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status
Energy Requirements
Basal metabolic rate--the energy needed to maintain life-sustaining activities for a specific period of time at rest.
Resting energy expenditure (REE)(aka resting metabolic rate)--the amount of energy that an individual needs to consume over a 24-hour period for the body to maintain all its internal working activities while at rest.
In general, when energy requirements are completely met by kilocalorie intake in food, weight does not change.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Chapter 44
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Guidelines for dietary change recommend reduced fat, saturated fat, sodium, refined sugar, and cholesterol, and increased intake of complex carbohydrates and fiber.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Scientific Knowledge Base: Nutrients

Carbohydrates are complex and simple saccharides; main source of energy.
Proteins: Amino acids; neccesary for nitrogen balance.
Fats: Saturated, polyunsaturated, and monounsaturated; calorie dense.
Water: All cell function depends on a fluid environment.
Vitamins: Essential for metabolism; water soluble or fat soluble.
Minerals: Catalysts for enzymatic reactions; macrominerals, trace elements.
Dietary Guidelines
Dietary reference intakes (DRIs):

Acceptable range of quantities of vitamins and minerals for each gender and age group.
Food guidelines:

Dietary guidelines, average daily consumption.
Daily values:
Needed protein, vitamins, fats, cholesterol, carbohydrates, fiber, sodium and potassium.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
ChooseMyPlate.gov provides practical information, tools, & resources for consumers about nutrition. MyPlate shows the five food groups in a place setting, so it is easy to see how much of each food is the appropriate amount.
Retrieved from http://www.choosemyplate.gov/about
Nursing Knowledge Base
Factors Influencing Nutrition
Environmental factors
Developmental needs
Infants through school age: Breastfeeding; formula; solid foods.
Adolescents
Young and middle adults
Older adults
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Alternative Food Patterns
Are based on religion, cultural background, ethics, health beliefs, and preference.
A vegetarian diet consists predominantly of plant foods:
Ovolactovegetarian avoids meat, fish, and poultry, but eats eggs and milk.
Lactovegetarian drinks mild but avoids eggs.
Vegan consumes only plant foods.
Fruitarian eats fruit, nuts, honey, and olive oil.
Zen macrobiotic diet consists of primarily brown rice, other grains, and herb teas.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Religious Dietary Restrictions
Muslim
Pork; alcohol; caffeine; Ramadan fasting sunrise to sunset for month; ritualized methods of animal slaughter required for meat ingestion.
Christianity
Some faiths, such as Baptists, have minimal to no alcohol; some meatless days may be observed, commonly during Lent.
Hinduism
All meats; fish and shellfish with
some restrictions; alcohol.
Judaism
Pork; predatory fowl; shellfish (eat only fish with scales); rare meats; blood (blood sausage); mixing of meat with dairy products; must adhere to kosher food preparation; 24 hours of fasting on Yom Kippur; no leavened bread during Passover; no cooking on the Sabbath (sundown Friday to sundown Saturday.
Mormons
Alcohol; tobacco, caffeine.
7th Day Adventist
Pork; fish & shellfish; alcohol, caffeine; vegetarian or ovolactovegetarian diets encouraged.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Critical Thinking Model for Nutrition Assessment
Assessment
Identify signs and symptoms associated with altered nutrition.
Gather data from patients regarding nutritional practices.
Determine patient's nutritional energy needs.
Obtain patient's dietary history.
Assess effects illness is having on ability to prepare meals at home.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Knowledge
Normal nutrition parameters
Anatomy & physiology of GI system
Cultural influences on nutrition
Developmental factors affecting nutrition
Effects of medications on nutrition
Patient-centered care principles for assessing patient values and preferences
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Experience
Caring for patients with altered nutrition
Observation of nutritional practices of friends and family
Personal assessment of nutritional practices
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Standards
Apply intellectual standards of accuracy, completeness, and significance when obtaining a health history for patients with altered nutrition
Compare gathered data with established nutritional standards (DRI, MyPlate, Healthy People 2020)
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Attitudes
Be open minded
Display confidence when collecting data
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Diagnoses R/T Nutrition
Risk for aspiration
Diarrhea
Deficient knowledge
Imbalanced nutrition or risk for: More or less than body requirements
Readiness for enhance nutrition
Feeding self-care deficit
Impaired swallowing
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Planning
Select nursing interventions to promote optimal nutrition; consistent with therapeutic diet
Consult with dietition, nutritionist, physician, pharmacist, PT and OT to adopt interventions that meet the patient's needs
Involve patient and family when designing interventions
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Implementation
Interventions include:
Health promotion, such as education; early I.D. of potential or actual problems; meal planning; weight loss plans; food safety.
Acute care-What are risk factors for an acutely ill patient?; gradual progression of intake or therapeutic diet to manage illness.
Promoting appetite
Assisting with oral feedings-When a patient needs help with eating, it is important to protect his or her safety, independence, and dignity.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Evaluation
Multidisciplinary collaboration remains essential in providing nutritional support.
Changes in condition indicate a need to change the nutritional plan of care.
Consider the limits of patients' conditions and treatments, their dietary preferences, and their cultural beliefs when evaluating outcomes.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Adaptive Feeding Equipment
People with physical, visual, or dexterity impairment can use cups, plates, and utensils adapted to meet their needs.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Enteral Tube Feeding
Enteral nutrition (EN) provides nutrients into the GI tract. It is physiological, safe, and economical nutritional support.
Nasogastic, jejunal, or gastric tubes
Surgical or endoscopic placement: Nasointestinal; gastrostomy; jejunostomy; PEG (percutaneous endoscopic gastrostomy); PEJ (percutaneous endoscopic jejunostomy).
Risk for aspiration
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Parenteral Nutrition
Nutrients are provided intravenously
Patients who are unable to digest or absorb enteral nutrition or are in highly stressed physiological states, such as sepsis; head injury; or burns.
Peripheral central line
Initiating parenteral nutrition
Preventing complications
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Test your knowledge!
The plan of care for your patient includes placement of a PEG tube with enteral feedings. Indications for EN include all EXCEPT:
A. Upper GI cancer
B. Dementia
C. Pancreatitis
D. Decreased appetite
E. Anorexia nervosa
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
The nurse has an order to obtain gastrointestinal aspirate from her patient's feeding tube. What is the appropriate order of steps to be taken:
1. Wash hands and put on clean gloves.
2. Draw back on syringe and obtain 5-10 ml of gastric aspirate.
3. Draw up 30 ml of air into syringe.
4. Attach syringe to feeding tube, and instill air.
5. Remove gloves and discard supplies.
6. Verify tube placement.
Correct answers: D and 6, 1, 3, 4, 2, 5.
Medical Nutrition Therapy (MNT)
Specific nutritional therapy usage for treating illness, injury, or a certain condition.
Necessary for metabolizing certain nutrients; correcting nutritional deficiencies; eliminating foods that worsen disease states.
Most effective with collaborative health care team and dietitian.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Gastrointestinal Diseases
Peptic ulcer etiology: Helicobacter pylori; stress; acid overproduction.
Peptic ulcer treatments: Avoid caffeine, spicy foods, aspirin, NSAIDs; consume small frequent meals.
Inflammatory bowel disease-Crohn's and idiopathic ulcerative colitis: Elemental diets; parenteral nutrition; vitamins and iron supplements; fiber increase; fat reduction; avoid large meals, lactose, and sorbitol.
MNT (cont'd)
Malabsorption Syndromes
Celiac disease: Gluten-free diet.
Short bowel syndrome: Intestinal surface decreases; lifetime EN or PN.
Diverticulitis: Inflammation of diverticula; low- to moderate-residue diet for infection; high-fiber diet for chronic conditions.
Diabetes Mellitus
Type 1: Insulin and dietary restrictions
Type 2: Exercise and diet therapy initially; individualized diet; carb consistency and monitoring; saturated fat <7%; cholesterol intake < 200 mg/dl; protein intake 15-20% of diet.
Goals: Normal to near-normal glucose levels; <100 mg low-density lipoprotein (LDL); < 130/85 mmHg; avoidance of hypoglycemia
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
MNT (cont'd)
Cardiovascular Disease
American Heart Association (AHA) dietary guidelines:
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Balance calorie intake and exercise.
Maintain a healthy body weight.
Eat a diet rich in fruits, vegetables, and complex carbohydrates.
Eat fish twice per week.
Limit foods and beverages high in sugar and salt.
Limit trans-saturated fat to <1%.
MNT (cont'd)
Cancer & Cancer Treatment
Malignant cells compete with normal cells for nutrients.
Anorexia, nausea, vomiting, and taste distortions are common.
Malnutrition associated with cancer increases morbidity and mortality.
Radiation causes anorexia, stomatitis, severe diarrhea, intestinal strictures, and pain.
Cancer Nutrition Management
Maximize fluid and nutrient intake; individualize diet choices to patient's needs, symptoms, and situation; encourage small frequent meals and snacks that are easy to digest.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
MNT (cont'd)
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Body wasting and severe weight loss.
Severe diarrhea, GI malabsorption, altered nutrient metabolism.
Hypermetabolism as a result of cytokine elevation.
Maximize kilocalories and nutrients.
Encourage small, frequent, nutrient-dense meals with fluid in between.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Assessment
Screening a patient is a quick method of identifying malnutrition or risk of malnutrition using sample tools: Height; weight; weight change; primary diagnosis; comorbidities; screening tools.
Anthropometry is the measurement system of the size and makeup of the body: An ideal body weight (IBW) provides an estimate of what a person should weigh; Body mass index (BMI) measures weight corrected for height and serves as an alternative to traditional height-weight relationships.
Anthropometry
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Dietary & Health History
Health status; age; cultural background; religious food patterns; psychological factors; personal food preferences; use of alcohol or illegal drugs; use of vitamin, mineral, or herbal supplements; prescription or over-the-counter (OTC) drugs; the patient's general nutrition knowledge.
Physical Examination
Dysphagia (difficulty swallowing)
Case Study
Decreased appetite, visible weight
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