Middle Column: Nutrition

Summarize normal physiology of nutrient metabolism.

The major nutrients are carbohydrates, proteins, lipids (fats), vitamins, minerals, and water. Carbohydrates, proteins, and fats supply energy and are termed macronutrients because the body needs them in large amounts to maintain health and well-being.Vitamins and minerals are considered micronutrients because they are needed in smaller amounts, this doesn’t mean their role in the body is any less important. Water is an essential nutrient needed for survival Adequate water intake contributes to fluid balance. It also has an important role in nerve and muscle functioning and in the transport of nutrients to all body systems.

macronutrients

Essential nutrients needed by the body in large amounts to survive: carbohydrates, proteins, and fats.

micronutrients

Essential nutrients needed by the body in small quantities, such as vitamins and minerals.

essential nutrient

The macro- and micronutrients needed for the body’s survival.

Carbohydrates

One of the three major macronutrients primarily derived from plant foods. These foods contain simple and complex sugars and starches.

Proteins

A macronutrient that contains nitrogen and is a critical component of all tissues in the human body, including muscle, bone, and blood.

Lipids

The macronutrient that provides most of the body’s energy at 9 kcal/g. There are three categories of lipids: triglycerides, phospholipids, and sterols. Also called fats

Saturated fats

A triglyceride fat that contains all of the hydrogen ions it is capable of holding.

Unsaturated fats

A triglyceride fat that does not contain all of the hydrogen ions it is capable of holding.

Vitamins

Micronutrient compounds that are involved in regulating body functioning. Most vitamins, with the exceptions of vitamins D and K, cannot be manufactured within the body and must be consumed through dietary intake.

Minerals

Salts dissolved in water that carry electrical charge and work with other nutrients to maintain fluid balance throughout the body. Also called electrolytes.

Water

comprises about 60% of an adult’s body weight and about 75% of an infant’s body weight. Obesity decreases the percentage of body weight from water. It serves the following functions in the body: Transports nutrients and wastes, Regulates metabolic processes, Serves as a solvent for vitamins, minerals, glucose, and amino acids, Acts as a lubricant, Acts as a cushion, Regulates body temperature, Maintains blood volume, and Assists in maintaining a healthy weight.

Identify common occurring alterations in nutrition and their related therapies.

Common alterations in nutrition include Food allergies, Food intolerances, Carbohydrate excess, Carbohydrate deficiency, Protein excess, Protein deficiency, Mineral excess, Mineral deficiencies, Vitamin excess, Vitamin deficiencies

Food alterations and their related therapy

• Food allergies

• Food intolerances

• Carbohydrate excess

• Carbohydrate deficiency

• Protein excess

• Protein deficiency

• Mineral excess

• Mineral deficiencies

• Vitamin excess

• Vitamin deficiencies

Food allergies

A hypersensitivity reaction of the immune system to a component in Food.

• Related therapies - Patients should avoid the food item, even in microscopic amounts, carry an epinephrine autoinjector, and wear a medical alert bracelet outlining the allergy.

Food intolerances

A combination of GI symptoms that occur following consumption of a certain food such as those contain lactose or gluten.

• Related therapies - Not associated with allergy. Intervention is avoidance of the particular food items.

Carbohydrate excess

Excess occurs when carbohydrate intake exceeds the recommended intake.

• Related therapies - Provide patients with the suggested intake for carbohydrates and provide education regarding weight management and appropriate exercise.

Carbohydrate deficiency

Deficiency occurs when carbohydrate intake is less than recommended.

• Related therapies - Provide patients with the suggested intake for carbohydrates and provide education regarding weight management and appropriate exercise

Protein excess

Excess occurs when protein intake exceeds the recommended intake.

• Related therapies - 

• Monitor blood urea nitrogen (BUN) and proteinuria.

• In the presence of renal failure, suggest further decreases in protein intake.

Protein deficiency

Deficiency occurs when protein intake is less than recommended.

• Related therapies - 

• Patients who are vegetarians may need assistance in maintaining adequate protein intake.

• Individuals with critical illnesses who are receiving alternative nutrition may need protein-replacement therapy.

Mineral excess

Excessive levels occur when intake of minerals such as calcium exceeds the recommended amount.

• Related therapies - Provide patients with lists of foods high in calcium. Teach the relationship between vitamin D and calcium absorption.

Mineral deficiencies

Deficiency occurs when mineral intake is insufficient.

• Related therapies - Provide patients with lists of foods high in calcium. Teach the relationship between vitamin D and calcium absorption.

Vitamin excess

Excessive levels occur when vitamin intake exceeds the recommended amount. Toxicity from vitamins A, D, E, and K is rare. Overdose of B vitamins can occur with use of supplements. Vitamin C is harmful only if megadoses are taken.

• Related therapies - Teach patients about the risks for excessive vitamin intake.

Vitamin deficiencies

Deficiencies occur when intake of vitamins is insufficient.

• Related therapies - 

• Vitamin K is administered to newborns to help with their immature liver function and to aid in coagulation.

• Encourage intake of foods rich in each of the vitamins.

• Teach that exposure to sunlight assists in vitamin D formation.

Differentiate common assessment procedures used to examine nutritional health across the Lifespan.

• Mini-Nutritional Assessment (MNA)

• Initial Screening

• Dietary Questionnaires

• Anthropometric Measurements

• Laboratory Data

Mini-Nutritional Assessment (MNA)

This tool is particularly useful for older adults. It includes questions about eating patterns, weight changes, and cognitive or emotional concerns. The MNA can quickly identify those at risk for malnutrition.

Initial Screening

Conducted upon hospital admission, this involves checking for recent weight changes, gastrointestinal symptoms, and food intake issues. If a patient is at "nutrition risk," a dietitian consult is recommended.

Dietary Questionnaires

These collect detailed information about food types, portion sizes, and frequency of consumption. They also address food allergies, intolerances, and cultural preferences.

Anthropometric Measurements

These include height, weight, and body mass index (BMI) assessments to evaluate nutritional status.

Laboratory Data

Blood tests can provide insights into nutritional deficiencies or imbalances.

Nutrition Across the Lifespan

• Infants

• Children

• Adolescents

• College Students

• Pregnant Women

• Adults

• Older Adults

Infants

• Parents should be instructed that the first week of life is critical in establishing infant eating habits, especially breastfeeding, and that nurses and lactation consultants are available both at hospitals and primary care offices to provide education and support.

• Remind parents that breastfeeding is encouraged for the first 6 months. Vitamin D supplementation may need to be added to the diet in breastfed infants.

• Formula is designed to be specific for each age group as babies grow. These changes allow for changes in the baby’s digestion system and nutrient needs.

Children

• Teach children about food groups and various nutrients that are available in food and how they help the body to grow. The MyPlate Kids’ Place is a good resource for children and their caregivers.

• Teach parents that when they are grocery shopping with children, they should ask them to point out various members of the four food groups and discuss how they relate to health.

• Work with parents to coordinate the nutritional health of preschool children who attend child care outside the home (Sharma et al., 2019).

Adolescents

• Give adolescents information about making healthy food choices and emphasize the importance of avoiding under- or overnutrition

• Provide adolescents with information regarding malnutrition including information about bulimia and anorexia.

• Fast-food consumption is associated with higher total calorie intake and poorer diet quality (Chaudhary et al., 2019; Jia, Luo, Zheng, & Xiao, 2019). Teach adolescents to limit intake of fast food and remind them that fast-food restaurants provide specific nutritional intake including the calories in each item on their menus.
  Teach adolescents that how they see themselves (their body image) may affect food choice and that consuming an adequate number of calories and nutrients is essential to their health now and in the future.
  Acknowledge that the impact of peers is significant, but remind adolescents that food choice is an individual decision.

College Students

• Twenty to 50% of college students are food insecure due to low income, college expenses, and working to pay for college.

• Remind college students that organizations in the community such as churches often provide free lunches 1 or 2 days a week.

• Teach college students about swapping traditional snack foods for healthier food items such as drinking tea instead of higher-calorie coffees or lattes.

• Suggest that students snack on fruits and veggies for in-between meals.

Pregnant Women

• Teach pregnant women the importance of eating breakfast. If they experience early nausea, they can consider eating dry toast.

• Teach pregnant women to drink plenty of fluids throughout the day and avoid too much caffeine.

• Eating foods that are high in fiber helps with nausea and aids in the prevention of constipation.

• Pregnant women should remember to take prenatal vitamins, which are important for iron and for folic acid.

• Increased calcium is also an essential part of the mother’s diet to promote adequate skeletal development

Adults

Food choice for adults is often set from earlier years. When health interruptions require alteration of food intake and moving to better food choices, adults will need education and support to transfer this knowledge to a lifestyle.

Older Adults

• Visit the dentist annually as chewing and swallowing are frequent problems for older adults and are direct factors in food choice.

• Loneliness and/or depression occur due to loss of a spouse and/or friends. Decreased appetite and social isolation may result. Refer older patients to local senior centers, help them sign up for Meals on Wheels, and encourage them to share their mealtimes with neighbors or friends.

• Some of the drugs taken to maintain health may contribute to alterations in taste and adversely affect nutritional status. Advise older adults to consult with their pharmacist or HCP if they notice a change in their nutritional status.

• Adjustments in eating, food choices, and meal planning may be necessary due to existing health conditions, for example, reduced salt for hypertension, reduced fat to lower cholesterol, and additional calcium to aid in bone health.

Describe diagnostic and laboratory tests to determine the individual’s nutritional status.

• Lipid Profile

• Complete Blood Count (CBC)

• Serum Glucose

• Serum Albumin and Total Protein Levels

• Prealbumin (PAB)

• Electrolyte Levels

• Bone Density Test

• Kidney, Thyroid, and Liver Function Tests

Lipid Profile

Assesses cholesterol levels, which can indicate malnutrition if below 160 mg/dL.

Complete Blood Count (CBC)

Identifies anemia, such as iron deficiency anemia.

Serum Glucose

Elevated levels may suggest prediabetes.

Serum Albumin and Total Protein Levels

Low levels can indicate protein deficiency or edema.

Prealbumin (PAB)

A sensitive marker for protein deficiency due to its short half-life.

Electrolyte Levels

Imbalances can indicate nutritional issues.

Bone Density Test

Checks for osteoporosis, often linked to malnutrition.

Kidney, Thyroid, and Liver Function Tests

Evaluate organ function affected by nutritional deficiencies.

Explain the role of nutritional health in the prevention of illness.

Plays a crucial role in preventing illness by ensuring a balance between nutrient intake and the body's needs. Food security is vital for maintaining nutritional health.Healthcare providers, including dietitians and nutritionists, play a significant role in advising on appropriate nutritional intake and diet planning to prevent and manage diseases.

Dietitians

Also called a nutritionist, a professional who provides expertise in the use of nutrition to treat disease.

Nutritionists

Also called a dietitian, a professional who provides expertise in the use of nutrition to treat disease.

Key Points of nutritional health in the prevention of illness.

• Nutritional Balance

• Food Choices

• Food Security

• Collaborative Care

• Assessment Methods

Nutritional Balance

Good nutritional health is achieved when there is a balance between nutrient intake and the body's needs. This balance helps prevent both overnutrition and undernutrition, which can lead to various health issues such as cardiovascular diseases and diabetes.

Food Choices

The types of food consumed significantly impact wellness and illness. For instance, excessive intake of high-calorie and high-fat foods can increase the risk of chronic diseases, while a diet rich in plant-based foods can help mitigate these risks.

Food Security

Access to nutritious food is essential. Food insecurity can lead to poor health outcomes, including weight loss, compromised immune systems, and chronic conditions like diabetes.

Collaborative Care

Healthcare providers, including dietitians and nutritionists, play a vital role in guiding individuals towards healthier dietary patterns to prevent illness.

Assessment Methods

Tools like food diaries and nutritional assessments help evaluate dietary habits and identify areas for improvement.

Demonstrate the nursing process in providing culturally competent and caring interventions across the lifespan for individuals with common alterations in nutrition.

• Assessment - Begin by assessing the patient's nutritional needs, cultural beliefs, and practices.This includes understanding their dietary restrictions, preferred foods, and any traditional remedies they might use.

• Diagnosis - Identify any nutritional issues, such as obesity, hepatitis, or osteoporosis, and consider how cultural factors might influence these conditions.

• Planning - Develop a care plan that incorporates the patient's cultural preferences while ensuring nutritional adequacy. This might involve meal accommodations, nutritional counseling, and incorporating preferred foods safely.

• Implementation - Implement the care plan by promoting safety and open communication. Ensure that the patient understands safety instructions and that any traditional remedies do not interfere with medical treatments.

• Evaluation - Continuously evaluate the effectiveness of the interventions and make adjustments as needed. Ensure that the patient and family members understand the importance of mobility and independence in activities of daily living (ADLs).

Develop an interdisciplinary plan for care for clients with alterations in nutrition

• Assessment - Conduct a comprehensive assessment of the client's nutritional status, cultural preferences, and any existing medical conditions. This involves collaboration with dietitians to evaluate dietary intake and nutritional needs.

• Diagnosis - Identify specific nutritional issues, such as malnutrition, obesity, or deficiencies, and consider how these might be influenced by cultural or lifestyle factors.

• Planning - Create a SMART-EST goal-oriented plan that includes:

• Specific - Set clear, actionable goals (e.g., increase vegetable intake).

• Measurable - Define how progress will be tracked (e.g., weekly weight checks).

• Achievable - Ensure goals are realistic for the client.

• Relevant - Align goals with the client's health needs and preferences.

• Time-bound - Set deadlines for achieving goals.

• Evidence-based - Use proven strategies and guidelines.

• Strategic - Tailor the plan to the client's readiness for change.

• Implementation - Collaborate with an interprofessional team, including dietitians, nurses, physicians, and possibly physical therapists, to implement the plan. This may involve dietary modifications, exercise programs, and possibly pharmacologic interventions.

• Evaluation - Regularly review the client's progress and adjust the plan as needed. Ensure open communication among team members and with the client to address any barriers or changes in condition.

Pathophysiology

refers to the functional changes that occur in the body as a result of a disease. For example, chronic bronchitis involves chronic bronchial irritation and inflammation, leading to bronchial edema, mucus hypersecretion, and airway obstruction.

Etiology

is the study of the cause of diseases. Chronic bronchitis can be caused by tobacco smoke and air pollution, leading to chronic irritation and inflammation.

Describe the pathophysiology, etiology, causes

• Environmental factors like tobacco smoke and air pollution are significant contributors to chronic bronchitis.

• Genetic factors, such as alpha-1 antitrypsin deficiency, can lead to the breakdown of lung tissue, contributin

Describe the pathophysiology, etiology, clinical manifestations.

• Fever - Tachycardia, tachypnea, elevated temperature, lethargy, and chills.

• Skin Inflammation - Redness, pain, warmth, and edema.

• Septicemia - Whole body inflammation with symptoms like fever, altered white blood cell count, tachycardia, and decreased cardiac output.