Nutrition

Nutrition Assessment - Subjective Data

Dietary habits, food preferences (cultural/religious), allergies, and risk factors like chronic diseases, surgeries, and medications.

Nutrition Assessment - Objective Data

Weight/height, BMI, waist/hip ratio, signs of malnutrition, dehydration, stool, hair, skin, nails, teeth, gums, mucous membranes, swallow studies, and lab values.

Daily Caloric Requirement Components

Basal Metabolic Rate (BMR), physical activity energy, and thermic effect of food (TEF).

Basal Metabolic Rate (BMR) Details

Energy for involuntary activities at rest (body temperature, breathing). Increases with male sex, growth, muscle mass, fever, and caffeine. Decreases with female sex, aging, reduced muscle mass, hypothyroidism, fasting, malnutrition.

Physical Activity & TEF Energy Needs

Physical activity (20% of energy needs) depends on intensity, duration, and weight. TEF (10%) is energy needed to digest and metabolize food.

BMI Categories & Calculation

Underweight: <18.5, Normal: 18.5-24.9, Overweight: 25-29.9, Obesity: 30+. Formula: Metric: weight (kg) / height (m²); Imperial: 703 x weight (lbs) / height (in²).

Lab Values - Nutrition Indicators

Serum albumin, prealbumin, hemoglobin, hematocrit, serum iron, ferritin, transferrin, vitamin/mineral levels (Vit D, B12, folate), CMP, glucose, electrolytes, liver enzymes, thyroid panel, lipid panel, glucose, HA1C.

Electrolyte Reference Ranges

Na+: 135–145 mEq/L, K+: 3.5–5 mEq/L, Ca++: 8.5–10.5 mEq/L, Cl-: 95–105 mEq/L, Mg+: 1.3–2.1 mEq/L, PO4: 1.7–2.6 mEq/L.

Nursing Diagnoses - Imbalanced Nutrition

"More Than Body Needs" - Due to overeating, sedentary lifestyle. "Less Than Body Needs" - Due to appetite loss, malabsorption, illness, causing weight loss, fatigue, deficiencies.

Risk for Imbalanced Nutrition

Excess - Linked to overeating, family obesity history, sedentary lifestyle. Deficient - Due to reduced appetite, inability to self-feed, illness, financial constraints.

Nursing Diagnoses - Oral and Swallowing Issues

Altered Oral Mucous Membrane - Affected by poor hygiene, dehydration, malnutrition. Impaired Swallowing - Caused by stroke, neurological or esophageal issues.

Nursing Diagnoses - Aspiration Risk & Enhanced Nutrition

Risk for Aspiration - Vulnerability to inhaling food/liquid. Readiness for Enhanced Nutrition - Motivation to improve diet, positive attitude.

Macronutrients - Percentages & Energy

Carbs: 45-65% (1g=4 kcal), Lipids: 20-35% (1g=9 kcal), Proteins: 10-35% (1g=4 kcal), Water: 2-3 L/day.

Carbohydrates - Types & RDA

Primary energy source. Simple (quick energy) vs. Complex (fiber, slower digestion). RDA: Males: 38 g/day, Females: 25 g/day.

Lipids - Functions & Types

Stored energy, cell structure, temperature regulation. Types: Saturated (animal fats), Trans (processed foods), Unsaturated (heart-healthy).

Cholesterol - Role & Guidelines

Essential for cell membranes, vitamin D synthesis. HDL (good), LDL (bad). RDA: <300 mg/day; <200 mg if at CV risk.

Proteins - Functions & Sources

Needed for tissue repair, immunity, wound healing. Found in seafood, dairy, seeds, beans, nuts, grains. Complete proteins contain all essential amino acids.

Water - Functions & Daily Needs

Critical for temp regulation, blood pressure, joint lubrication. Intake: 30 mL/kg body weight (2-3 L/day).

Water Loss - Sensible vs. Insensible

Sensible: measurable (urine). Insensible: unmeasurable (sweating, breathing). Dehydration signs: weight loss, tachycardia, dry mucous membranes.

Vitamin A - Function & Deficiency

Vision, immune function, cell growth. Sources: carrots, liver. Deficiency: night blindness, dry eyes. Toxicity: high intracranial pressure, joint pain.

Vitamin D - Role & Deficiency

Calcium absorption, bone health. Sources: sunlight, fish oil, fortified foods. Deficiency: rickets (children), osteomalacia (adults). Toxicity: hypercalcemia, muscle weakness.

Vitamin E - Role & Deficiency

Antioxidant, immune support. Sources: seeds, nuts, green vegetables. Deficiency: neuropathy, ataxia. Toxicity: bleeding risk.

Vitamin K - Functions & Deficiency

Bone maintenance, blood clotting. Sources: leafy greens, oils. Deficiency: bleeding risk. Toxicity is rare but affects those on blood thinners.

B-Complex Vitamins - Overview

B1-Thiamine: prevents beriberi. B2-Riboflavin: prevents cheilosis. B3-Niacin: prevents pellagra. B9-Folic Acid: neural tube defect prevention. B12: RBC production. Sources: meat, greens, fortified cereals.

Vitamin C - Functions & Deficiency

Antioxidant, collagen, iron absorption. Sources: citrus, tomatoes, peppers. Deficiency: scurvy (bleeding gums, poor wound healing). Toxicity: GI upset, kidney stones.

Key Electrolytes - Calcium, Magnesium, Phosphorus

Calcium - Bone health (dairy). Magnesium - Muscle/nerve function (nuts). Phosphorus - Bone mineralization (dairy). Deficiencies cause spasms, weakness.

Potassium & Sodium - Role & Sources

Potassium - Fluid balance, heart function (bananas). Sodium - Nerve/muscle function, fluid balance (salt, processed foods).

Trace Minerals - Iron, Fluoride, Iodine, Zinc

Iron - Hemoglobin (meat). Fluoride - Tooth decay prevention (treated water). Iodine - Thyroid hormone synthesis (iodized salt). Zinc - Wound healing (meat).

Dietary Regimens - Types

Clear liquid, full liquid, soft, mechanical soft, bland, low-sodium, low-fat, low-fiber, diabetic, renal, high-calorie, gluten-free, enteral nutrition.

Enteral Nutrition - Guidelines

HOB at 30-45 degrees. Check residual (<500 mL, return to stomach). Flush with water (30 mL every 4 hrs). Change tubing daily.

Parenteral Nutrition - Precautions

Central line required (PICC or catheter). Monitor blood glucose. Discard TPN after 24 hrs.

Religious Dietary Considerations

Buddhist (vegetarian), Roman Catholic (meat restrictions during Lent), Hindu (no alcohol), Islam (no pork/alcohol), Judaism (kosher).

Vegetarian Diets - Variations & Nutrient Needs

Vegan (no animal products), Lacto-vegetarian (dairy allowed), Pescatarian (includes fish). Ensure sufficient B12, iron, calcium.

Aspiration Precautions

Prevent materials from entering lungs. Consult nutrition and speech therapy, conduct swallow study if needed.