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