Nutrition, Fluids, and Electrolytes Study Notes

MyPlate

USDA's food management system that comprises 5 basic food groups: Protein, Grains, Fruits, Vegetables, and Dairy.

Six Essential Nutrients

Proteins, Carbohydrates, Fats, Water, Minerals, and Vitamins.

Proteins

Essential for building and maintenance/repair of body tissues.

Carbohydrates

Primary source of energy; 1 gram = 4 kcal.

LDL (Low Density Lipoproteins)

Known as "bad cholesterol"; carries cholesterol throughout the body, depositing it in arteries. Goal:

HDL (High Density Lipoproteins)

Known as "good cholesterol"; carries cholesterol to the liver for excretion. Goal: >60 mg/dl.

Total Cholesterol

Measure of all cholesterol (LDL + HDL). Goal:

Fat-Soluble Vitamins

Vitamins A, D, E, K.

Water-Soluble Vitamins

Vitamins B and C complex; cannot be stored in the body.

Major Minerals

Minerals present in the body in amounts >5 grams (e.g., calcium, phosphorus, sodium, potassium, magnesium).

Trace Minerals

Minerals present in amounts

Water Recommendation

6-8 eight-ounce glasses or 1500-2000 ml per day.

Fiber Daily Requirement

Average adult requires 25-35 grams per day.

Normal BMI

18.5 – 24.9.

NPO (Nil Per Os)

Nothing by mouth; commonly used before surgery or for GI concerns.

Clear Liquid Diet

Composed of non-pulp liquids such as water, broth, fruit juices, flavored gelatin, and tea.

Full Liquid Diet

Includes full liquids such as creamed soups, milk, ice cream, yogurt without fruits, and pudding.

Enteral Nutrition

Nutrition administered via a tube (e.g., NG, NJ, gastrostomy, jejunostomy) directly into the GI tract.

Parenteral Nutrition

Nutrition administered via a central venous catheter, bypassing the GI tract.

Total Parenteral Nutrition (TPN)

Delivers a high concentration of carbohydrates, protein, vitamins, minerals, and electrolytes via a central venous catheter.

Fluid Volume Deficit (Dehydration)

Symptoms include increased temperature, thirst, weakness, postural hypotension, decreased urine output.

Fluid Volume Excess (Overhydration)

Symptoms include weight gain, bounding pulse, elevated blood pressure, and edema.

Normal Urinary Output

1-3 liters per day; acceptable hourly output should be 30 mL.

Oliguria

Urinary output less than 30 mL/hr.

Polyuria

Urinary output more than 3,000 mL/day.

Anuria

Absence of urine.

Dysuria

Painful urination.

Specific Gravity of Urine

1.010-1.030, indicating hydration status.

Sodium Normal Range

135-145 mEq/L; regulates water and blood pressure.

Potassium Normal Range

3.5-5.0 mEq/L; essential for heart muscle and nerve function.

Calcium Normal Range

9-11 mg/dL; essential for bones and muscle contraction.

Magnesium Normal Range

1.3-2.1 mEq/L; involved in energy transfer.

Phosphate Normal Range

1.7-2.6 mEq/L; crucial for bone health.

Unit IIIB Overview

Covers Chapters 15, 16, 29, 30, 31 from Timby's Introductory Medical-Surgical Nursing, Thirteenth Edition by Lippincott CoursePoint, taught by Professor Munoz.

Nutrition

USDA

A
A’s MyPlate food management system, replacing MyPyramid, comprises 5 basic food groups: Protein, Grains, Fruits, Vegetables, and Dairy.

Six Essential Nutrients

Proteins, Carbohydrates, Fats, Water, Minerals, Vitamins.

MyPlate Food Management System

Visual breakdown includes Dairy, Fruits, Grains, Vegetables, Protein. Resource: ChooseMyPlate.gov.

Food Label - Serving Size

1/2 cup (114g).

Food Label - Servings Per Container

4.

Food Label - Calories

90 (from fat: 30).

Daily Value for Total Fat (2,000/2,500 cal diet)

65g/80g.

Proteins

Essential for building body tissues during growth, and for the maintenance and repair of tissues.

Carbohydrates

Primary source of energy. 1 gram = 4 kcal.

LDL (Low Density Lipoproteins)

Known as "bad cholesterol"; carry cholesterol throughout the body, depositing it in arteries. Goal: <100 mg/dl.

HDL (High Density Lipoproteins)

Known as "good cholesterol"; carry cholesterol to the liver for excretion. Goal: >60 mg/dl.

Total Cholesterol

Measure of all cholesterol (LDL + HDL). Goal: <200 mg/dl.

Vitamins

Vital for normal metabolism. Highest content found in fresh foods.

Fat-Soluble Vitamins

Vitamins A, D, E, K.

Water-Soluble Vitamins

Vitamins B and C complex (cannot be stored in the body).

Minerals

Inorganic elements in all body tissues and fluids, essential for metabolism and cellular function.

Major Minerals

Present in the body in amounts >5 grams (e.g., calcium, phosphorus, sodium, potassium, magnesium).

Trace Minerals

Present in amounts <5 grams (e.g., iron, iodine, zinc, fluoride, copper).

Water

Most essential nutrient, comprises 60-70% of total body weight. Recommended daily intake: 6-8 eight-ounce glasses or 1500-2000 ml.

Water Balance Equation

Water intake = urine output + other losses.

Fiber

Average adult requires 25-35 grams per day. Sources include fruits, vegetables, whole-grain foods, cereals, pasta, potatoes, rice.

Components of Nutritional Assessment

Medical, family, and social history; height and weight; Body Mass Index (BMI); signs of malnutrition, allergies, blood levels of albumin, hemoglobin, hematocrit, fats, and cholesterol.

Normal BMI Range

18.5 – 24.9.

Underweight BMI

<18.5.

Overweight BMI

25 – 29.

Obese BMI

$\ge30$.

Diabetic Diet

Manages calories and carbohydrates.

Calorie-Restricted Diet

For weight loss.

Sodium-Restricted Diet

For hypertension and heart disease (reduces fluid).

Fat-Restricted Diet

Lowers cholesterol or assists in weight loss.

Renal/Protein-Restricted Diet

For kidney and liver diseases.

Regular Diet

No specific nutritional needs, unrestricted food selections.

NPO (Nil Per Os)

Commonly used before surgery or diagnostic studies, or for GI concerns.

Clear Liquid Diet

Composed of non-pulp liquids such as water, broth, fruit juices, flavored gelatin, popsicles, soft drinks, tea, and coffee. Provides hydration and calories in the form of simple carbohydrates.

Full Liquid Diet

Includes creamed soups, milk, ice cream, yogurt without fruits, pudding, milkshakes, etc.

Soft Diet

Low residue, digestible foods, few spices/condiments, fewer fruits/vegetables/meats.

Mechanical Soft Diet

For chewing difficulties, includes cooked fruits & vegetables, and ground meats.

Pureed Diet

Foods processed in a blender.

Patient Feeding Procedures

Prepare the patient for mealtime (handwashing, sitting upright, pre-medication if needed), ensure correct diet tray and appropriate food temperature, encourage self-feeding, monitor intake.

NG tube

Terminates in the stomach.

NJ tube

Terminates in the small intestine.

Gastrostomy tube

Surgically inserted into the stomach.

Jejunostomy tube

Surgically inserted into the jejunum.

Tube Feeding Indications

Decompress the stomach, provide nutrition or medications, specimen collection, or for patients with no appetite or during comatose states.

Tube Feeding Procedures

Ensure tube placement is confirmed (aspiration and pH checks), secure placement with tape, keeping it centered to avoid pressure ulcers. Verify placement and residual volume before feedings. Flush with water for patency before and after medications/feedings.

Enteral Feeding Formulas

Types include High Protein, Diabetic, etc.

Intermittent Tube Feedings

Administered in equal portions, may involve gravity or feeding pump.

Continuous Infusion Feeding

Administered via infusion pump over an extended period; ensures better tolerance and absorption.

Parenteral Nutrition

Administered via a central venous catheter, bypassing the GI tract.

Total Parenteral Nutrition (TPN)

Delivers a high concentration of carbohydrates, protein, vitamins, minerals, and electrolytes.

Partial Parenteral Nutrition (PPN)

Less concentrated, given through a peripherally inserted central catheter for patients meeting some nutritional needs orally.

Health Issues Related to Nutrition

Conditions such as Anorexia Nervosa, Bulimia, Obesity, Pregnancy, Smoking, HIV & AIDS, pre- and post-operative considerations.

Functions of Water

Maintains body temperature, transports nutrients, cushions organs, lubricates joints, removes toxins, vehicle for transport, thermoregulation, acid-base balance, and medium for digestion.

Electrolytes

Minerals or salts dissolved in bodily fluid essential for balance, acid-base maintenance, enzyme function, and neuromuscular activity.

Sodium (Normal Range)

135-145 mEq/L. Regulates water and blood pressure; excess (Hypernatremia) by dehydration, excessive input; deficiency (Hyponatremia) from loss or dilution.

Chloride

Aids HCl production in stomach, balances fluids.

Potassium (Normal Range)

3.5-5.0 mEq/L. Essential for heart muscle and nerve function; excess (Hyperkalemia) can cause cardiac issues, while deficiency (Hypokalemia) impacts muscle and cardiovascular function.

Calcium (Normal Range)

9-11 mg/dL. Essential for bones and muscle contraction; Hypercalcemia leads to weakness; Hypocalcemia causes muscle spasms and cardiac changes.

Magnesium (Normal Range)

1.3-2.1 mEq/L. Involved in energy transfer; Hypermagnesemia can cause lethargy, while hypomagnesemia causes twitching and cardiac dysfunction.

Phosphate (Normal Range)

1.7-2.6 mEq/L. Crucial for bone health; Hyperphosphatemia often results from renal failure, while hypophosphatemia can cause weak bones and muscle function issues.

Clinical Applications (Electrolytes)

Normal and abnormal findings in electrolyte levels should be monitored closely, especially during IV therapy. Nurses should assess and document electrolyte imbalances carefully, as they can lead to severe complications.

Fluid Volume Deficit (Dehydration)

Symptoms include increased temperature, thirst, weakness, postural hypotension, decreased urine output.

Fluid Volume Excess (Overhydration)

Symptoms include weight gain, bounding pulse, elevated blood pressure, and edema.

Urinary System Functions

Blood filtration, waste removal, excess water removal, electrolyte regulation, and acid-base balance.

Normal Urinary Output

1-3 liters per day, with acceptable hourly output of 30 mL.

Oliguria

Less than 30 mL/hr urinary output.