Nutrition

NUTRITION STUDY GUIDE

Learning Objectives

  • Define the concept of nutrition.

  • Discuss the six classes of nutrients, explaining the significance of each.

  • Discuss MyPlate and how to interpret an FDA food label.

  • Identify factors that affect nutrition and food intake.

  • Discuss how to obtain a nutritional assessment.

  • Identify the various types of diets.

  • Identify appropriate nursing diagnoses, client outcomes, and interventions for nutritional-related problems.

  • Discuss diet counseling and client teaching in relation to client expectations.

Concept: Nutrition

  • Definition: Nutrition is the study of the nutrients and how they are handled by the body, as well as the impact of human behavior and the environment on the process of nourishment.

Nutrients

Essential Nutrients

  • Definition: Must be provided in the diet.

  • Macronutrients: These are nutrients required in larger amounts.
      - Types:
        - Carbohydrates
        - Fats
        - Proteins

  • Micronutrients: Nutrients required in smaller amounts.
      - Types:
        - Vitamins
        - Minerals

Non-Essential Nutrients

  • Definition: Not required for survival or can be synthesized in the body in adequate amounts.

Classes of Nutrients

Carbohydrates

  • Commonly known as sugars and starches.

  • Classified as simple or complex carbohydrates.

  • Converted to glucose for transport through the blood or for use as energy.

  • Primary Function: Energy source.

  • In excess, stored as triglycerides in adipose tissue.

  • Recommended: 45-65% of total calories.

Proteins

  • Classified as complete (contain all essential amino acids) or incomplete (lack one or more essential amino acids).

  • Required for the formation of all body structures.

  • Primary Function: Growth and repair of tissues, production of enzymes and hormones.

  • In excess, stored as adipose tissue.

  • Recommended: 10-35% of total calories.

Fats

  • Also known as triglycerides and lipids.

  • Classified as saturated, unsaturated, and trans fats.

  • Required for the absorption of fat-soluble vitamins (A, D, E, K).

  • Primary Function: Insulation, cushioning organs, and providing energy.

  • Recommended: 20-35% of total calories.

Vitamins

  • Needed in trace amounts.

  • Primary Function: Facilitate metabolic processes (carbohydrates, protein, and fats).

  • Water-Soluble Vitamins:
      - Includes: B-complex vitamins, Vitamin C.
      - Absorbed through water into the bloodstream.
      - Not stored in the body; daily intake is recommended.

  • Fat-Soluble Vitamins:
      - Includes: Vitamins A, D, E, K.
      - Absorbed through fats into lymphatic circulation.
      - Excess stored in body tissues.

Minerals

  • Inorganic elements found in body fluids and tissues.

  • Help provide structure to bones and teeth or help regulate body processes.

  • Macrominerals: Needed in larger amounts (e.g., calcium, phosphorus).

  • Microminerals: Needed in trace amounts (e.g., iron, zinc).

Water

  • Accounts for approximately 60% of total body weight.

  • Vital to life; more critical than food components.

  • Acts as a solvent, lubricant, and temperature regulator.

  • Sources: Does not have to be ingested directly; can be obtained through food and metabolism.

  • Recommended Intake: Approximately 2,500 mL/day.

Energy

  • Definition: Needed for any activity; obtained from food.

  • Caloric Values:
      - Carbohydrates = 4 calories/gram
      - Protein = 4 calories/gram
      - Fat = 9 calories/gram

Key Terms Related to Energy

  • BMR (Basal Metabolic Rate): The rate at which the body burns energy at rest.

  • BMI (Body Mass Index): A measure of body fat based on height and weight.

Dietary Reference Intakes (DRIs)

  • Recommended Dietary Allowance (RDA): Recommended average daily intake level.

  • Adequate Intake (AI): A recommended intake value based on observed or experimentally determined estimates.

  • Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects.

  • Estimated Average Requirement (EAR): The daily intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group.

MyPlate: A Guide

  • Concept: MyPlate divides a plate into four sections to visualize portion sizes and food varieties.
      - Fruits: Half of the plate should include fruits and vegetables. Choose a variety of colors for maximum nutrient intake.
      - Vegetables: Aim to fill half your plate with vegetables, prioritizing non-starchy options.
      - Grains: Choose whole grains over refined grains. Whole grains have more fiber, iron, and B vitamins.
      - Protein: Include a palm-sized portion of lean proteins (beans, fish, chicken, nuts) in meals.
      - Dairy: Aim for 3 servings of low-fat dairy daily for calcium intake.

FDA Food Label Interpretation

Key Sections

  1. Serving Size: Basis for determining the nutritional content. Given in standard units and metric amounts.

  2. Amount of Calories: Critical for weight management. Lists total calories and calories from fat per serving.

  3. Percent Daily Values (%DVs): Indicates nutrient contribution to the daily diet based on a 2,000-calorie intake.

  4. Nutrients to Get Enough Of: Guidance on nutrients that are often under-consumed in American diets, such as dietary fiber, vitamins A and C, calcium, and iron.

  5. Nutrients to Limit: Lists total fat, cholesterol, and sodium, which should be limited to reduce chronic disease risks.

  6. Footnote: Provides daily values for various nutrient recommendations based on 2,000 or 2,500 calorie diets.

  7. Comparison: Use serving sizes to compare food items for better nutritional choices.

Factors Affecting Nutrition

Developmental Considerations

  • Varying nutritional needs throughout the life cycle (infancy, childhood, adolescence, adulthood, and elderly).

Physiologic and Physical Considerations

  • Impact of physical health or alterations in physiological states (e.g. pregnancy, activity levels) on nutritional needs.

Sociocultural and Psychosocial Considerations

  • Influence of cultural beliefs, social environment, economic status, and mental health on food choices and nutritional intake.

Nutritional Assessment

  • Methods of Assessment:
      - Dietary Intake: 24-hour recall, food dairy, food frequency records, and full diet history.
      - Medical and Socioeconomic Data: Understanding medical history, social interactions, and economic factors.
      - Anthropometric Data: Accurate height and weight assessments, BMI, waist circumference calculations.

Clinical Observations for Nutritional Assessment
Signs of Good Nutritional Status

  • Alertness and energy

  • Shiny, lustrous hair

  • Pink, moist lips

  • No dental cavities

  • Smooth skin

  • Well-developed muscles

  • Psychological stability

  • Normal vital signs (HR, BP)

Signs of Poor Nutritional Status

  • Listlessness

  • Fatigue

  • Dry, brittle hair

  • Dark circles under eyes

  • Missing teeth

  • Pale skin

  • Spoon-shaped nails

  • Difficulty walking

  • Depression

  • Swollen abdomen

Biochemical Data

  • Prealbumin: Normal range = 19–38 mg/dL; decreased levels indicate protein depletion or malnutrition.

  • Albumin: Normal range = 3.5-5.2 g/dL; decreased levels indicate malnutrition.

  • Blood Urea Nitrogen (BUN): Normal range = 6–20 mg/dL; increased levels indicate starvation, high-protein intake, or dehydration; decreased levels indicate malnutrition or low-protein diet.

  • Total Protein: Normal range = 6.0-8.0 g/dL; decreased levels indicate reduction in total muscle mass or severe malnutrition.

Nursing Diagnoses

Imbalanced Nutrition as the Problem

  • Imbalanced Nutrition: Less Than Body Requirements.

  • Obesity.

  • Risk for Overweight.

Imbalanced Nutrition as the Etiology

  • Fatigue.

  • Constipation.

  • Risk for Impaired Skin Integrity.

Outcome Planning and Implementation

  • Goal: Maintain or restore optimal nutritional status.

  • Nutritional Education: Educating the client on dietary options and nutritional needs.

  • Monitoring Nutritional Status: Keeping track of client nutritional intake and health status.

  • Simulate Appetite: Encouraging appetite through various means.

  • Assist with Eating: Support clients during meals to ensure adequate nutrient intake.

Providing Nutrition

Types of Diets

  • Normal/Regular Diet

  • Vegetarian Diet

  • Modified Consistency Diet

  • Clear or Full Liquid Diet

  • Pureed Diet

  • Mechanically Altered Diet

  • Therapeutic Diets:
      - Consistent-Carbohydrate Diet
      - Fat-Restriction Diet
      - High-Fiber Diet
      - Low-Fiber Diet
      - Sodium-Restricted Diet
      - Renal Diet
      - NPO (nothing by mouth)

Nutritional Evaluation

  • Assessing progress toward nutritional outcomes.

  • Evaluating tolerance and adherence to the prescribed diet.

  • Client understanding of dietary interventions and nutrition.

  • Communication effectiveness.

  • Necessary revisions to dietary plans based on evaluations.