Nutrition

Nutrients Nutrients are biochemicals that are essential for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury1. Nutrients can be divided into essential and nonessential.

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Essential nutrients must be obtained through diet or supplementation, as the body cannot synthesize them adequately1.

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Nonessential nutrients do not need to be acquired through dietary sources because they are either not required or are adequately synthesized by the body2.

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Water Water accounts for 50% to 60% of an adult's total weight and is more vital than food3. It is essential for chemical reactions in the body, acting as a solvent and aiding in digestion, absorption, circulation, and excretion. The recommended daily intake is 2,200-3,000 ml3.

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Carbohydrates Carbohydrates, including sugars and starches, are organic compounds composed of carbon, hydrogen, and oxygen4. They are the most abundant and least expensive source of calories5. 90% of carbohydrate intake is ingested, then converted to glucose for transport through the blood5.

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Simple carbohydrates include sugars with little nutritional value, such as those found in soda and baked goods5.

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Complex carbohydrates include fiber and starch, offering higher nutritional value found in fruits, vegetables, nuts, beans, and whole grains5.

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Proteins Proteins are required for the formation of all body structures6. They are classified as complete (high quality) or incomplete (low quality) based on their amino acid composition6. Protein tissues are in a constant state of flux, undergoing catabolism (breakdown) and anabolism (building)7.

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Lipids (Fats) Lipids are insoluble in water and blood, composed of carbon, hydrogen, and oxygen8. They are the most concentrated source of energy in the diet9.

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Saturated fats contain more hydrogen, are mostly animal fats, and are solid at room temperature8. They tend to raise serum cholesterol8.

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Unsaturated fats contain less hydrogen, are mostly vegetable-based, and are liquid at room temperature8. They tend to lower serum cholesterol8.

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Vitamins Vitamins are organic compounds needed by the body in small amounts and are classified as water-soluble or fat-soluble9.

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Water-soluble vitamins (C and B complex) are not stored by the body and are excreted in the urine10.

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Fat-soluble vitamins (A, D, E, and K) are stored in the liver and fatty tissue10. Excessive intake can be toxic, especially with vitamins A and D10.

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Minerals Minerals are inorganic elements found in all body fluids and tissues10. They provide structure and help regulate body processes3.

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Physiology of Nutrition

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Digestion Digestion of fats/lipids occurs largely in the small intestine9. Water also aids digestion3.

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Absorption Vitamins are absorbed through the intestinal wall directly into the bloodstream9.

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Metabolism Vitamins are needed for the metabolism of carbohydrates, protein, and fat9.

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Energy expenditure Energy expenditure is the sum of physical activity and basal metabolism

Foundations of Diet Therapy4

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Dietary Guidelines:

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MyPlate is designed to help consumers make better food choices by recommending balanced calories, increased intake of fruits and vegetables, whole grains, fat-free or low-fat dairy, reduced sodium and sugary drinks, and increased water consumption5. It also emphasizes the importance of activity and exercise5.

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Dietary Reference Intakes (DRIs) define the amounts of energy, nutrients, and other dietary components needed, as well as physical activity recommendations1. DRIs include Recommended Dietary Allowances (RDAs)1.

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Developmental Guidelines: Nutritional needs vary across the lifespan2.

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Infants (0-12 months) Rapid growth occurs, with birth weight doubling in 4-6 months and tripling by 1 year6. Breastfeeding is recommended6. Solid foods are typically introduced at 4-6 months starting with iron-fortified cereal7.

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Toddlers/Preschoolers (1-5 years) Growth rate slows, and erratic eating patterns are common8. They may be picky eaters with strong food preferences8.

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School Age (6-10 years) Children experience slow, steady growth with increased appetite9.

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Adolescents (11-18 years) Experience a growth spurt at puberty10.

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Young-Middle Age Adults Energy needs decline, but intake often does not11.

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Pregnancy/Lactation Pregnancy increases metabolic needs12. Lactation requires 500 kcal above pre-pregnant needs and 60 grams of protein13.

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Older Adults (65+) Older adults often have a lower Basal Metabolic Rate (BMR) and need to reduce calories14.

II. Nursing Process3

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Recognizing and Analyzing Cues: Assessment of nutritional needs involves identifying actual or potential needs for all patients3.

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Subjective Assessment: Gathering dietary, medical, and socioeconomic data3.

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History Includes medical and diet history3....

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Culture/Religious Influences Factors influencing food choices16.

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Dietary Habits Gathering information regarding typical food choices15.

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Economic Economic factors that affect food choices16.

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Medications Medications can affect nutrition16....

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Weight Changes Significant weight changes18.

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Past Medical History Past medical history including GI, oral problems, cancer, eating disorders, AIDS, alcoholism, and therapeutic diets15.

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Increased/Decreased Activity Activity level and exercise requirements11.

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Appetite Altered smell or taste18.

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Bowel Pattern Assess bowel function

Therapeutic Diets Tailored to specific health conditions3.

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High Fiber Diet: Encourages increased intake of fruits, vegetables, whole grains, and fluids4.

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Carbohydrate Consistent Diet: (ADA Diet) Distributes carbohydrates evenly throughout the day to maintain consistent blood glucose levels, beneficial for diabetes mellitus and hypoglycemia5....

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Low Protein Diet: Used in renal dysfunction to minimize nitrogenous wastes7....

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Mechanical Soft Diet: Alters food texture for easier chewing and swallowing9....

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Controlled Electrolyte Diets8

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Sodium Restricted Diet: Limits sodium intake to manage hypertension, edema, renal disease, liver disease, and CHF8....

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Potassium Restricted Diet: Used to prevent a potentially fatal build-up of potassium12.

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Progressive Diets13

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Clear Liquid Diet: Provides fluids, calories, and electrolytes while minimizing digestive stimulation14.

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Full Liquid Diet: Includes all clear liquids plus soups, milk, creams, sherbet, ice cream, custard, pudding, eggnog, vegetable, and strained fruit juice15....

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Soft Diet: Transition between liquid and regular diets, minimizing fiber, and excluding fried, highly seasoned, or gas-causing foods9....

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Regular Diet: No dietary restrictions10....

2. Stimulating Appetite17

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Identify and address the underlying causes of poor appetite17.

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Serve small, frequent meals with attractive presentation17.

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Offer a choice of foods and season them to taste17.

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Consider liquid supplements17.

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Encourage exercise and provide oral hygiene before meals17.

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Ensure the patient is in a comfortable sitting position and has received pain medication, if needed17.

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Make sure patients have their dentures in to eat17.

3. Assisting with Meals18

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Provide a comfortable environment by ensuring the patient has used the bathroom, washed their hands and face, and received oral care19.

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Remove unpleasant odors and clutter18.

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Allow sufficient time for meals and offer assistance as needed18.

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Check the tray against the diet order and client's name band and allergy bracelet18....

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Serve hot foods hot and cold foods cold, and document food and liquid intake18.

4. Assistance and Feeding18...

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Disabled Clients: Wash hands, provide comfort, arrange the tray, avoid rushing, sit down and visit, use a spoon and straw, and give small bites18....

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Visually Impaired Clients: Describe the location of food using a clock face analogy and guide their hand to reinforce the location21.

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Clients with Dementia: Maintain consistency in time, place, and assistants, reduce distractions, place the plate close to the patient, remove clutter, guide the hand to the mouth, and offer finger foods21....

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Clients with a Sore Mouth: Avoid dry, acidic, spicy, and salty foods. Offer moist, soft foods, cold water, ice chips, ice cream, and saliva substitutes. Ensure good oral hygiene, avoiding alcohol-based mouthwash22....

5. Managing Swallowing Difficulties (Dysphagia)22...

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Have suction equipment available and observe swallowing24.

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Assist the client into a sitting position and provide semi-solid foods with some texture24.

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Offer quarter-sized bites, encourage the client to tuck their chin, and remind them to swallow 2-3 times24.

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Check the mouth for retained food, maintain a 30-degree head-of-bed elevation after meals, and watch for coughing and choking24.

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Always place food on the unaffected side of the mouth24.

6. Managing Nausea/Vomiting, Constipation, Diarrhea, and Flatulence

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These interventions are not specifically described in the provided text.

7. Enteral Feeding25...

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Utilize the GI tract by feeding directly into the stomach, which is less expensive and maintains intestinal mucosa integrity26.

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Confirm proper placement before medication or feeding instillation, maintain the head of the bed elevated at 30-45 degrees, and manage potential complications such as diarrhea, constipation, or tube occlusion27....

8. Total Parenteral Nutrition (TPN)29

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Bypass the GI tract by providing nutrients via IV therapy29.

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Administer TPN through a central venous access device due to its high concentration29.

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Monitor for complications such as infection, air embolus, hyperglycemia, and hypoglycemia

Women, Infants, and Children (WIC) Provides federal grants for supplemental foods, healthcare referrals, and nutrition education to low-income pregnant, breastfeeding, and postpartum women, as well as infants and children up to age 5 at risk for nutritional deficiencies2.

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Food Stamps (SNAP) A government-issued voucher, which is exchangeable for food and is income-based2. It is issued through Electronic Benefits Transfer (EBT)2.

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American Diabetes Association (ADA) Committed to preventing and curing diabetes and improving the lives of those affected by it3. The ADA provides education, recipes, support, blogs, and research3.

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American Heart Association (AHA) Provides education on healthy living, weight management, nutrition support, and cooking tips3.

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Local Support Groups Mercy Nutrition Center and Cox Outpatient Nutrition Services in Springfield, MO, offer support, as well as Diabetes Support and Heart Disease support via Cox Health in the Branson, MO area1.

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American Cancer Society (ACS) Helps educate about healthy nutrition choices to reduce the risk of cancer and provides food safety guidance