Nutrition (Class 16)

Nutrition

A basic component of health and essential for normal growth/development, tissue maintenance, repair, cellular metabolism, and organ function

Healthy People 2030 Nutrition Goals

• Increase the number of breastfed infants
• Reduce obesity
• Increase the number of adults seeking medical care related to weight reduction
• Increase the amount of calcium. potassium, and vitamin D the population is getting
• Eliminate very low food security
• Reduce the number of adults with hypertension and high cholesterol
• Increase the proportion of schools in school-feeding programs
• Reduce the number of women of childbearing age that have iron deficiency
• Increase nutrition as an option as part of the employee health program

Basal Metabolic Rate (BMR)

Energy needed at rest to maintain life-sustaining activities for a specific amount of time.

Factors Affecting BMR

• Age
• Body Mass
• Gender
• Starving or Fasting
• Fever
• Menstruation
• Any Kind of Illness
• Activity Level
• Thyroid Function

Carbohydrates

• Main source of energy
• 4 Kcal/gram
• Glucose is necessary for brain, muscle, and blood cell production
• Simple vs. complex carbs
• Fiber
• Ex. Oats and Barley

Proteins

• Essential for the growth, maintenance, and repair of body tissue.
• 4 kcal/gram
• Provides energy but because its essential role is to promote growth, maintenance, and repair it is spared and carbs are broken down first.
• Collagen, hormones, enzymes, immune cells, DNA, and RNA are all made of this.
  • Ex. Albumin and Insulin
• Must be provided by the diet
• Ex. Fish, poultry, milk, cheese, and eggs.

Complete Protein

Contains all essential amino acids

Incomplete Proteins

Missing one or more of the nine indispensable amino acids and include grains, seeds, nuts, legumes, and vegetables.

Complementary Proteins

Pairs of incomplete proteins that, when combined, supply the total amount of protein provided by complete protein sources. Ex. Rice and Beans.

True

True or False: Soy is the only plant source of a complete protein.

Lipids

• 9 kcal/gram
• Carry out metabolic processes
• Most-calorie dense (hardest to rid due to energy required to breakdown)
• Saturated and unsaturated, Choelsterol and triglycerides

Saturated Fat

• Ex. Meats, butter, and dairy products
• Solid at room temperature
• Increase levels of LDL cholesterol

LDL Cholesterol

• Clogs the arteries
• “Bad cholesterol”

Unsaturated Fats

• Vegetable oils
• Liquid at room temperature
• Increase levels of HDL cholesterol

HDL Cholesterol

• “Good Cholesterol”
• Grabs LDL and escorts it to the liver where it is broken down and eventually removed from the body.

Water

• Critical because cell function depends on a fluid environment.
• Makes up 60-70% of total body weight.

Vitamins

• Organic substances that are essential to normal metabolism.
• Fat soluble (DAKE) high risk of toxicity (hypervitaminosis)
• Water soluble (BC)

Minerals

• Inorganic elements essential to the body as catalysts in biochemical reactions.
• Silicon, vanadium, nickel, tin, cadmium, arsenic, aluminum, and boron are trace elements.

Macrominerals

Minerals that humans need more than 100 mg of

Anabolism

The building of more complex biochemical substances by synthesis of nutrients. Occurs when an individual adds lean muscle through diet and exercise.

Catabolism

The breakdown of biochemical substances into simpler substances and occurs during physiological states of negative nitrogen balance.

Dietary Reference Intakes

Present evidence-based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age-group.

Estimated Average Requirement (EAR)

Recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population based on age and gender.

Recommended Dietary Allowance (RDA)

Represents average needs of 98% of the population, not the exact needs of the individuals.

Adequate Intake (AI)

Suggested intake for individuals based on observed or experimentally determined estimates of nutrient intakes

Tolerable Upper Intake Level (TUIL)

Highest level that likely possess no risk of adverse health events.

Muslim Dietary Considerations

• Pork
• Alcohol
• Ramadan fasting sunrise to sunset for a moth
• Ritualized methods of animal slaughter required for meat ingestion

Christianity Dietary Considerations

• Some denominations (Ex. Baptists) allow minimal or no alcohol.
• Some meatless days may be observed during the calendar year, commonly during Lent.

Jewish Dietary Considerations

• Pork
• Predatory fowl
• Shellfish (eat only with scales)
• Rare meats
• Blood (Ex. blood sausage)
• Mixing of milk or dairy products with meat dishes
• Must adhere to kosher food preparation methods
• 24 hour fasting on Yom Kippur, a day of atonement.
• No leavened bread eaten during Passover (8 days)
• No cooking on the Sabbath from sundown Friday to sundown Saturday

Mormon Dietary Considerations

• Alcohol
• Tobacco
• Caffeine such as in teas, coffees, and sodas

Seventh-Day Adventists Dietary Considerations

• Pork
• Shellfish
• Fish
• Alcohol
• Caffeine
• Vegetarian or Ovolactovegetarian diets encouraged

Vegetarianism

Consumption of a diet consisting predominantly of plant foods

Ovolactovegetarian

Avoid meat, fish, and poultry but eat eggs and milk.

Lactovegetarians

Avoid meats and eggs but drink milk

Vegans

Consume only plant foods, no animal derived products.

Anthropometry

The systematic method of measuring the size and makeup of the body by taking height and weight.

Underweight

<18.5 BMI

Overweight

25-29.9 BMI

Normal

18.5-24.9 BMI

Obese

30-34.9 BMI

Extremely Obese

35< BMI

Nutritional Status Lab Tests

• Albumin
• Prealbumin
• Transferrin
• Retinol Binding Protein
• Total Iron Binding Capacity
• Hemoglobin

Factors Affecting Nutritional Status Lab Values

• Hemorrhage
• Fluid Balance
• Liver Function
• Kidney Function
• Underlying Disease
• Drainage From Wounds
• Steroid Medications
• Age
• Trauma
• Stress Burns

Clinical Manifestations of Poor Nutrition

• Easily fatigued
• Cachectic
• Underweight or overweight
• Flaccid muscles
• Anorexia
• Thin and brittle hair and nails
• Edema
• Hair loss
• Pallor

Nursing Interventions to Stimulate Appetite

• Keep a patient’s environment free of odors
• Provide oral hygiene as needed to remove unpleasant tastes
• Offering smaller, more frequent meals
• Encourage visitors to eat with a patient

Clear Liquid

Clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, and popsicles.

Full Liquid

Same as clear liquid, with addition of smooth-textured dairy products (Ex. ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurts.

Dysphagia/Thickened Liquids/Pureed

As for clear and full liquid, with addition of scrambled eggs; pureed meats, vegetables, and fruits; mashed potatoes and gravy.

Mechanical Soft

As for clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked dish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried.)

Soft/Low Residue

Addition of low-fiber, easily digested foods such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables; desserts, cakes, and cookies without nuts or coconut.

High Fiber

Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits.

Low Sodium

No more than 4-g (no added salt); vary from no added salt to severe sodium restriction which requires selective food purchases.

Low Cholesterol

300 mg/day cholesterol, in keeping with American Heart Association guidelines for serum lipid reduction.

Diabetic

Nutrition recommendations by the American Diabetes Association; focus on total energy, nutrient and food distribution; include a balanced intake of carbs, fats, and proteins; varied caloric recommendations to accommodate patient’s metabolic demands.

Gluten Free

Eliminates wheat, oats, rye, barley, and their derivatives.

Regular

No restrictions unless specified.

Dysphagia

• Difficulty swallowing
• High risk for aspiration

Dysphagia Symptoms

• Coughing during eating
• Change in voice tone or quality after swallowing
• Abnormal movements of the mouth, tongue, or lips
• Slow, weak, imprecise, or uncoordinated speech
• Abnormal gag reflex
• Delayed swallowing or pocketing
• Drooling

Complications of Dysphagia

• Aspiration pneumonia
• Dehydration
• Decreased nutritional status and weight loss
• Leads to disability or decreased functional status
• Increased mortality

Enteral Feedings

• NG-Tube
• G/J-Tube

True

True or False: Enteral feedings are only given to patients with a functional GI tract.

Continuous Feeding

Providing EN by a feeding pump over 24 hours per day.

Cyclic Feeding

Providing EN by a feeding pump in less than a 24-hours time period (Pauses for several hours)

Intermittent Feeding

Providing EN over 20-60 minutes every 4-6 hours with or without a feeding pump.

Bolus Feeding

EN over a very short period of time at specified time interval by gravity or with a syringe.

Priority Assessment For Enteral Feedings

• Check placement of tube before administering feeding
• Check residual before each feeding or every 4-6 hours (continuous)
• Assess for bowel sounds each shift
• Maintain integrity of feeding system
• Clean or replace feeding apparatus every 24 hours

Dumping Syndrome

Physiological response of the patient when feedings are emptied rapidly into the small intestines from the stomach. Signs and Symptoms are distention, cramping, dizziness, and weakness.

True

True or False: Under 200 residual is good and over 250 is bad.

Parental Feedings

• A form of specialized nutritional support provided intravenously
• Who are unable to digest or absorb EN benefit
• Basic formula is a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements.
• Administered through a central line, is a 2-in-1 formula in which administration of fat emulsions occurs separately from the protein and dextrose solution.

Assessment of PN and TPN

• Blood glucose monitoring: hypo, hyperglycemia
• Vital signs
• Respiratory assessment
• Catheter-sterile techniques
• Tubing change
• S/S of infection
• Electrolyte imbalances

Enteral Feeding Complications

1. Aspiration
2. Diarrhea
3. Constipation
4. Tube occlusion
5. Tube displacement
6. Cramping/vomiting
7. Delayed gastric emptying
8. Electrolyte imbalances
9. Fluid Overload
   10. Dehydration

Parenteral Feeding Complications

1. Electrolyte Imbalance
2. Hypercapnia
3. Hyperglycemia
4. Hypoglycemia
5. HHNS
6. Infection/Sepsis
7. CVC complications