Nutrition Fundamentals Study Notes

Nutrition Fundamentals Ch. 15

Objectives

  • Define nutrition and explain the functions of each of the six classes of major nutrients.
  • Discuss the concepts of the MyPlate Food Guidance System and the Nutrition Facts Label.
  • Discuss BMI, obesity, and malnutrition and how they relate to a healthy diet.
  • Differentiate between the various types of diets and explain when a client may need additional assistance.
  • Identify the nutritional concerns for a client throughout the lifespan and state the nursing considerations for each concern.

Definitions

  • Nutrition: Food or nourishment necessary for health and growth.
  • Malnutrition: A condition resulting from a lack of proper nutrients in the diet; can result in serious health issues.
  • Obesity: A condition characterized by an excessive amount of body fat that increases the risk of health problems such as cardiovascular disease.

Assessment of Nutrition

  • Nurses assess clients for the following:
    • Unintended weight loss.
    • Muscle wasting.
    • Delayed wound healing.

At Risk for Malnutrition

  • Malnutrition is common among individuals in poor, developing countries, but also prevalent in the United States among:
    • Older adults who are socially isolated or living on fixed incomes.
    • Homeless individuals.
    • Children from low socioeconomic backgrounds.
    • Pregnant teens.
    • Individuals struggling with substance abuse issues, particularly alcoholism due to a high risk for thiamine deficiency.
    • Clients with eating disorders such as anorexia nervosa and bulimia nervosa.
    • Clients suffering from chronic illnesses, e.g., cancer and COPD.

Factors Influencing Eating Habits

  • Food Preferences: Often developed in childhood.
  • Meal Patterns: Established routines for meals.
  • Cultural and Religious Beliefs: Impact food choices (e.g., kosher diets).
  • Knowledge of Nutrition: Affects the ability to make informed food choices.
  • Income Level: Determines accessibility to various foods.
  • Time for Preparation: Affects the quality of meals.
  • Household Size: Influences food purchasing and preparation.
  • Food as Comfort: Emotional associations with food.
  • Body Satisfaction: The level of comfort or dissatisfaction with one’s body weight.

Calories and Energy

  • Food serves as the source of energy for humans.
  • When macronutrients (proteins, carbs, and fats) are metabolized, they produce energy.
  • The amount of calories required varies based on:
    • Age
    • Body size
    • Physical condition
    • Physical activity level
  • Older adults need fewer calories but the same or higher amounts of protein to counteract muscle loss.
  • Nutrient-dense food examples for older adults include meats, fruits, vegetables, soy-based proteins, dairy products, and whole grains.

Human Nutritional Needs

  • Macronutrients: Nutrients required in large amounts
    • Proteins: Composed of amino acids; essential for building, maintaining, and repairing tissue.
    • Carbohydrates: The primary source for quick energy; categorized by sugar unit (saccharide).
    • Fats: Concentrated energy sources made up of glycerol and fatty acids; necessary for absorption of certain vitamins.

Nutritional Needs (Micronutrients)

  • Minerals (Electrolytes): Essential for proper bodily functions (e.g., calcium, sodium).
  • Vitamins: Chemical substances necessary for bodily maintenance.
    • Water-Soluble Vitamins: E.g., Vitamins B and C. Dissolved in water; excreted in excess, requiring regular intake.
    • Fat-Soluble Vitamins: E.g., Vitamins A, D, E, and K. Stored in the body and can be toxic in excess.

Specific Vitamins

  • Vitamin A (Retinol): Important for vision, immunity, skin, teeth, and reproduction.
  • Vitamin B1 (Thiamine): Essential for energy metabolism and brain function.
  • Vitamin C (Ascorbic Acid): Crucial for tissue growth, repair, collagen synthesis, and iron absorption; deficiency can lead to scurvy.
  • Vitamin D (Calciferol): Vital for bone health, muscle and nerve health, immunity, and calcium/phosphorus absorption; deficiency may lead to rickets (weak bones).
  • Vitamin K (Menadione): Necessary for blood clotting and bone health; deficiency can lead to excessive bleeding.

Symptoms of Scurvy

  • Symptoms include:
    • Bleeding of the skin and mucous membranes.
    • Fatigue and depression.
    • Decosh, gingivitis, and loose teeth.
    • Rough, dry skin and increased susceptibility to infection.
    • Muscle weakness and joint pain.
  • Symptoms of an overdose can include:
    • Nausea and stomach cramps.
    • Diarrhea.

Electrolytes

  • Sodium: Maintains water and electrolyte balance.
  • Potassium: Crucial for regular heart rhythms and muscular activity.
  • Magnesium: Important for neuromuscular activity, bone formation, and blood pressure regulation.
  • Phosphorus: Essential for bone, teeth, muscle contractions, and waste filtration in kidneys.
  • Calcium: Necessary for teeth and bone formation; regulates blood pressure and heartbeat.

Proteins

  • Structure: Comprised of amino acids, essential for building and repairing body tissues.
    • Essential Amino Acids: Must be obtained through the diet; the body cannot manufacture them.
    • Nonessential Amino Acids: Can be produced by the body.
  • Sources of Protein: Include both animal (milk, eggs, meat, fish) and plant sources (legumes, nuts, grains).

Carbohydrates

  • Classification: Grouped by sugar units into:
    • Monosaccharides: E.g., glucose and fructose.
    • Disaccharides: E.g., sucrose.
    • Polysaccharides: E.g., starches.
  • Function: The body's main source of quick energy.
  • Sources: Include cereals, grains, fruits, vegetables, and sweeteners.
  • Diet Considerations: Older adults may consume higher carbohydrate diets due to changes in taste or food preparation abilities.

Fats

  • Function: Used to build cell membranes, nerve tissues, and hormones; serve as concentrated energy sources.
  • Types of Fats:
    • Saturated Fats: Found in red meats and dairy; solid at room temperature; associated with increased cholesterol and cardiovascular disease risks.
    • Unsaturated Fats: Found in fish, poultry, and most plant oils; generally considered healthier.

Cholesterol

  • Types:
    • High-Density Lipoprotein (HDL): Known as “good cholesterol”; levels of greater than or equal to 60 mg/dL are considered healthy.
    • Low-Density Lipoprotein (LDL): Known as “bad cholesterol”; should be less than 100 mg/dL to minimize cardiovascular disease risks.
  • Total Cholesterol: Should be below 200 mg/dL; levels of triglycerides should also be under 150 mg/dL to reduce the risk of pancreatitis.

Health Risks Related to Fat and Cholesterol

  • Associated Risks:
    • Obesity
    • Heart disease
    • Hypertension
    • Diabetes
    • Some cancers

Nutritional Labeling

  • Importance: Guidelines for disease prevention and understanding nutritional content per serving.
  • Key Focus:
    • Amount of nutrition per serving (using familiar measurements).
    • Percentage of daily value (DV) per serving.
    • Vitamin/mineral content per serving.
  • Regulations: The federal Nutrition Labeling and Education Act mandates compliance with standard definitions for health-related claims on labels.

MyPlate

  • Personalization: Food group amounts can be customized based on age, gender, and activity level.

Sodium in Diets

  • Health Impact: Excess sodium can lead to increased water retention and a greater risk of kidney disease and hypertension.
  • High Sodium Foods: Examples include:
    • Smoked or cured meats (e.g., bacon, deli meats).
    • Frozen, breaded meals (e.g., burritos, pizzas).
    • Canned entrees.
    • Salted nuts and canned beans.

Nutritional Status Assessment

  • Data Types:
    • Subjective Data: Client's perception/opinion, diet history.
    • Objective Data: Measurements including:
    • Body mass index (BMI).
    • Body measurements (midarm circumference, triceps skinfold, abdominal circumference).
    • Physical assessment (general appearance, oral health, skin, hair, flexibility).
    • Laboratory data (glucose, serum albumin, cholesterol, triglycerides).

Management of Nutrition-Related Issues

  • Obesity: Defined as BMI equal to or exceeding 30, or triceps fold greater than 15mm.
  • Emaciation: Excessive leanness.
  • Cachexia: General wasting of body tissue.
  • Anorexia: Loss of appetite due to various factors.
  • Nausea Management: Temporary fluid intake limits and prescribed medications.
  • Vomiting: Identified as emesis; strategies needed for prevention.
  • Stomach Gas: Encouraging ambulation helps with peristalsis.
  • Eructation: Chewing with mouth closed to minimize belching.
  • Flatus: Encouragement of ambulation to reduce vehicle wind.

Weight Loss Facts

  • Caloric Deficit for Weight Loss: To lose one pound, reduce caloric intake by 3,500 calories/week (or 500 calories/day).
  • Healthy Weight Loss: Aiming for 1-2 pounds per week is considered healthy.
  • Professional Guidance: Encouraging clients to consult a dietitian for monitored weight loss, especially when considering unsupervised weight-loss methods.

Nursing Interventions Related to Nutrition

  • Identifying Nutritional Problems:
    • Imbalanced nutrition: less than body requirements.
    • Deficient knowledge regarding nutrition.
    • Impaired swallowing mechanisms.
    • Imbalanced nutrition: more than body requirements.
    • Self-care deficits around feeding.
    • Risks for aspiration.

Management of Client Nutrition

  • Nursing Responsibilities:
    • Ordering and canceling diets, serving meals, monitoring intake.
    • Understanding client's prescribed diet characteristics and purposes.

Common Hospital Diets

  • Regular Diet: Allows unrestricted food choices.
  • Soft Diet: Composed of softer texture foods; fewer fruits and vegetables than a light diet (e.g., yogurt, bananas).
  • Mechanical Soft Diet: Suitable for clients with chewing difficulties; more cooked fruits and vegetables and ground meats than a soft diet.

Diet Types

  • Cardiac Diet: Low in sodium, fat, and sugar; promotes heart health.
  • Renal Diet: Restricts protein, sodium, potassium, and phosphorus; may include fluid restrictions.
  • Diabetic Diet: Low in carbohydrates and sugars; healthy carbs are permitted (fruits, vegetables, whole grains).
  • Low Residue Diet: Utilized for bowel issues; low in fiber and easy to digest.
  • Dysphagia Diet: May involve thickened liquids depending on speech therapy recommendations.
  • Liquid Diets:
    • Full Liquid: Includes juices, soups, milk, ice cream, yogurt, etc.
    • Clear Liquid: Water, broth, fruit juices, gelatin, clear soft drinks.

Nutrition Delivery Methods

  • Enteral Nutrition: Direct nutrient delivery into the GI tract via a tube.
  • Parenteral Nutrition: Intravenous nutrient delivery when the GI tract is non-functional (e.g., Total Parenteral Nutrition).
  • Purpose: Maintains nutritional status, supports healing, prevents malnutrition; used in conditions like stroke or dysphagia.

Feeding Strategies

  • Dysphagia Clients:
    • Use thickened liquids; have suction equipment available.
    • Ensure proper positioning and monitor for aspiration risks.
  • Clients with Visual Impairments:
    • Assistance with self-feeding and arranging finger foods.
    • Cut food into manageable pieces and describe food placement as a clock.
  • Clients with Dementia:
    • Build rapport to ensure continuity of care.
    • Minimize distractions and simplify eating environments; offer finger foods for ease.

Maternity Nutrition

  • Importance of proper diets and prenatal vitamins.
  • Recommended increases:
    • 300 additional calories per day.
    • Increased protein, iron, folic acid, vitamins A and C.
    • Daily fluid intake of 8-10 glasses (4-6 glasses should be water).

Dieting Considerations

  • Weight Loss Strategy: Create a 500-calorie deficit daily for about 1 pound of weight loss weekly; increase exercise and consume healthy snacks.
  • Diet Types:
    • DASH Diet: Aims to lower blood pressure; low in salt and saturated fat, while rich in fiber, whole grains, calcium, and protein.
    • Kosher Diet: Prohibits pairing of meat and dairy.
    • Atkins Diet: High protein, low carbohydrate regimen.
    • Mediterranean Diet: Focuses on fish, seeds, oils, vegetables, fruits, small amounts of lean meats, and low-fat dairy.
    • Vegetarian/Vegan Diets: Abstains from animal products, includes only plant-based nutrition.