Fundamentals of Nursing - Nutrition

Effects of Aging on GI Tract

  • Dental caries and tooth loss
  • Decreased gag reflex
  • Decreased sense of taste
  • Decreased muscle tone at sphincters
  • Decreased gastric secretions
  • Decreased peristalsis

Building a Balanced Plate

  • Divide the plate into sections for vegetables, lean protein, and carbohydrates.
  • Include fruit and water as part of the meal.

Nutrients

  • Building blocks essential for normal functioning.
  • One food can contain multiple nutrients.

Proteins

  • Function: Essential for the body.
  • Types: Essential and nonessential amino acids.
  • Daily requirement: 46-56 grams.
  • Serving size: 3 oz.

Food Sources of Protein

  • Animal sources (complete proteins): Red meat, eggs, milk and milk products, poultry, fish.
  • Plant sources (incomplete proteins): Grains, legumes, and most vegetables.

Protein Deficiency

  • Marasmus: A form of protein-energy and nutrient malnutrition, often seen in infants after weaning.
  • Kwashiorkor: A condition occurring in infants and young children due to protein deficiency.

Protein Excess

  • Stressful to the liver and kidneys.
  • Can lead to excess fat in the diet.

Vegetarian Diets

  • Lacto-ovo-vegetarian: Includes dairy products, eggs, and plant foods.
  • Lactovegetarian: Excludes eggs but includes dairy products and plant foods.
  • Vegan: Excludes all animal food sources, including honey.

Carbohydrates

  • Function: Provide energy to the body.
  • Daily requirement: 130 grams.
  • Three main types: Simple, complex, and fiber.

Simple Carbohydrates

  • Cause a quick rise in serum glucose levels.

Complex Carbohydrates

  • Broken down into simple sugars for use by the body.
  • Provide a more consistent serum glucose level than simple sugars.
  • Recommended intake: 85% to 95% of consumed carbohydrates should be complex carbohydrates.

Fiber

  • Increases bulk in the stool.
  • May decrease absorption of fat.
  • Recommended intake: 21 to 38 g/day.

Fats (Lipids)

  • Essential nutrient.
  • Function: Made up of fatty acids and glycerol.
  • Daily requirement: 25-30% of daily caloric intake or 20-30 grams.

Types of Fats

  • Unsaturated fats: Corn oil, safflower oil, canola oil, olive oil, vegetables, nuts, seeds.
  • Saturated fats: Animal sources and solid fats.

Omega-3 Fatty Acids

  • The most unsaturated form of fatty acid.
  • Sources: Salmon, halibut, sardines, tuna, canola oil, soybean oil, chicken, eggs, and walnuts.
  • Should be added to the diet as sources of unsaturated fats.

Vitamins

  • Essential nutrients.
  • Easily absorbed into the bloodstream.
  • Water-soluble vitamins: B-complex vitamins and vitamin C.
  • Fat-soluble vitamins: A, D, E, and K. Absorbed in the small intestine and stored in the liver.

Minerals

  • Inorganic substances found in animals and plants.
  • Essential for metabolism and cellular function.
  • Must be provided by food sources or supplements.
  • Examples: Calcium, magnesium, potassium, sodium, iron, zinc.

Water

  • Most essential of all nutrients.
  • Adult body is 50% to 69% water.
  • Water requirement: 1 mL/calorie of intake.
  • General rule: Intake needs to be equal to recorded output plus 500 mL.

Factors Influencing Nutrition

  • Age
  • Illness
  • Emotional status
  • Economic status
  • Religion & Culture

Nutritional Needs Through the Life Span

Adulthood

  • Often rely on fast foods and convenience foods.
  • Obesity and hypertension are prevalent.

Older Adults

  • Most at risk for inadequate nutrition.
  • May need to decrease calories if activity level decreases.
  • Consider barriers and how to overcome them.

Nutritional Assessment

  • History
  • Physical exam
  • Height/Weight
    • Normal BMI: 18.5−24.918.5-24.9
    • Waist circumference: Males less than 40 in, Females less than 35 in.
  • Lab values

Nursing Diagnosis

  • Imbalanced nutrition: less than body requirements.
  • Risk for imbalanced nutrition: greater than body requirements.
  • Risk for deficient knowledge.
  • Impaired swallowing
  • Risk for aspiration

Planning Goals

  • Examples:
    • "Will consume 2200 calories per day."
    • "Will restrict caloric intake to 1800 calories per day."
    • "Will consume at least 50% of a pureed diet at each meal."
    • "Will provide examples of heart-healthy meals."

Implementation

  • General interventions
  • Client/Family teaching

Evaluation

  • Review goals
  • Determine if the client achieved them, partially achieved them, or did not achieve them.

Goals of Diet Therapy

  • Treat and manage disease
  • Prevent complications and restore health
  • Requires a physician's order
  • May need assistance with feeding

Therapeutic Diets

  • Regular
  • NPO (nothing per oral)
  • Clear liquids
  • Full liquids
  • Soft
  • Pureed diet
  • Calorie restricted
  • Low-Fat
  • Sodium restricted
  • Low-Carb

Health Issues RT Nutrition

  • Anorexia Nervosa
  • Bulimia
  • Obesity
  • Pregnancy
  • Substance Abuse

Cardiovascular Disease

  • Diseases of the blood vessels, hypertension, myocardial infarction, and congestive heart failure
  • Management:
    • Reduction of fat
    • Reduction of sodium intake
    • DASH diet

Diabetes Mellitus

  • Type 1
  • Type 2
  • CHO (carbohydrate) diet

Assisted Feedings

  • Indicated when a patient is unable to tolerate oral intake.
  • Considerations:
    • Dysphagia
    • Aspiration
    • Thickened liquids
    • Pureed Foods

Enteral Tubes

  • Purpose: To provide nutrition when oral intake is not possible.
  • Types:
    • NG (nasogastric) tube
    • Gastrostomy (PEG) tube
    • Jejunostomy tube

Nursing Process

  • Assessment
  • Nursing Diagnosis
    • Noncompliance
    • Deficient knowledge
    • Risk for aspiration
  • Goals

Nursing Care

  • Implementation
  • Oral/nasal care

Evaluation

  • Review goals
  • Determine if goals were met
  • Documentation