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

  • Components:
    • Fruit
    • Vegetables
    • Healthy lean protein (1/4 of the plate)
      • Examples: Fish, beans, eggs, milk, yogurt, cheese, tofu, meat
    • Carbohydrates (1/4 of the plate)
      • Examples: Whole wheat bread, oats, brown rice, peas, sweet potato, corn
    • Plenty of non-starchy vegetables (1/2 of the plate)
    • Healthy Fats:
      • Examples: Avocado, nuts, seeds, olives and their oils
    • Water

Nutrients

  • Building blocks for the body
  • Essential for normal functioning
  • One food can contain multiple nutrients

Proteins

  • Function: Essential
  • Types: Essential and nonessential amino acids
  • Daily Requirement: 46-56 grams
  • Serving Size: 3 oz.

Food Sources of Protein

  • Complete Animal sources
    • Red meat, eggs, milk and milk products, poultry, fish
  • Incomplete Plant sources
    • Grains, legumes, and most vegetables

Protein Deficiency

  • A form of protein energy and nutrient malnutrition
  • Marasmus
    • A condition occurring in infants and young children soon after weaning from breast milk
  • Kwashiorkor

Protein Excess

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

Vegetarian Diets

  • Lacto-ovo-vegetarian: Dairy products, eggs, and plant foods included in the diet
  • Lactovegetarian: Eggs are excluded; dairy products and plant foods included
  • Vegan: All animal food sources are excluded, including honey

Carbohydrates

  • Function
  • Daily requirement: 130 grams
  • Three main types:
    • Simple: Cause a quick rise in serum glucose
    • Complex: Broken down into simple sugars for use by the body; provide a more consistent serum glucose level than simple sugars provide
      • Recommended that 85% to 95% of consumed carbohydrates are 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
    • 20-30 grams

Unsaturated Fats

  • Sources: Corn oil, safflower oil, canola oil, olive oil, vegetables, nuts, seeds

Saturated Fats

  • Sources: Animal sources, 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
    • Absorbed in the small intestine
    • Stored in the liver
    • A, D, E, and K

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

  • Water is the most essential of all nutrients
  • Adult body is 50% to 69% water
  • Water requirement is 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

  • Rely on fast foods and convenience foods.
  • Obesity and hypertension prevalent
  • Recommendations

Older Adults

  • Most at risk for inadequate nutrition
  • May need to decrease calories if activity level is decreased
  • Barriers?
  • How to overcome them?

Nutritional Assessment

  • History
  • Physical exam
  • Height/Weight
    • Normal 18.5-24.9 BMI
  • 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

  • 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
  • Did the client achieve them?
  • Did the client partially achieve them?

Goals of Diet Therapy

  • Treat and manage disease
  • Prevent complications and restore health
  • Physician order
  • May need assistance with feeding

Therapeutic Diets

  • Regular
  • NPO
  • Clear liquids
  • Full liquids
  • Soft
  • Pureed diet
  • Calorie restricted
  • Low-Fat
  • Sodium restricted
  • Low-Carb

Health Issues Related to Nutrition

  • Anorexia Nervosa
  • Bulimia
  • Obesity
  • Pregnancy
  • Substance Abuse
  • Cardiovascular Disease
    • Diseases of the blood vessels, hypertension, myocardial infarction, and congestive heart failure
    • Reduction of fat
    • Reduction of sodium intake
    • DASH diet
  • Diabetes Mellitus
    • Type 1
    • Type 2
    • CHO diet

Assisted Feedings

  • Unable to tolerate oral
  • Dysphagia
  • Aspiration
    • Thickened liquids
    • Pureed Foods

Enteral Tubes

  • Purpose
  • NG
  • Various types
    • Gastrostomy (PEG)
    • Jejunostomy

Nursing Process

Assessment

Nursing Diagnosis

  • Noncompliance
  • Deficient knowledge
  • Risk for aspiration

Goals

Nursing Care

Implementation

  • Oral/nasal care

Evaluation

  • Review goals
  • Were goals met?
  • Documentation