PB

Nutrition

Definition of Nutrition

  • Nutrition is the process by which the body takes in, absorbs, transports, utilizes, and eliminates nutrients.

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Importance of Nutrition

  • Good nutrition is critical for promoting healthy outcomes.

  • Approximately 60% of adults have one or more diet-related chronic conditions.

Dietary Guidelines for Americans

  • Utilizes the MyPlate Food Guide.

  • Key goals:

    • Reduce excessive caloric intake.

    • Increase consumption of nutrient-dense foods to minimize chronic disorders.

MyPlate Essentials

    • Vegetables:

      • Dark green, red, orange, beans, peas, lentils, starchy, and others.

    • Fruits:

      • Emphasis on whole fruit.

    • Grains:

      • At least half should be whole grains.

    • Dairy:

      • Fat-free or low-fat milk, yogurt, cheese, and lactose-free alternatives.

    • Protein:

      • Lean meats, poultry, fish, beans, peas, lentils, nuts, seeds.

    • Oils:

      • Vegetable oils and oils from food sources like seafood.

Nutrition Facts Label Overview

  • Key updates in the new Nutrition Facts label:

    • Larger, bold serving sizes and calorie counts.

    • Inclusion of % Daily Value (DV) and additional nutrients (vitamin D, potassium, added sugars).

  • The DV indicates how much a nutrient contributes to a daily diet based on a 2,000-calorie intake.

  • The original label was not as easily seen to make people more health conscious.

Dietary Supplements

  • Defined as products intended to supplement the diet:

    • May include vitamins, minerals, herbs, amino acids.

  • Regulated by the FDA (Not as regulated/monitored as pharmaceutical agents) and may contain active ingredients with potential harm.

Drug and Supplement Interactions

  • Calcium

  • CoQ10/Fish oil

  • Garlic

  • Ginkgo bilboa

  • St. Johns wort

  • Niacin (B3)

  • Vitamin B12

  • Vitamin B6

  • Vitamin D

  • Vitamin A

  • Echinacea

  • Evening Primrose Oil

  • Ginseng

Food-Drug Interactions

  • Grape Fruit Juice

  • Alcohol

  • Leafy greens

    • Vitamin K will interact with anticoagulants and decrease effects

  • Tyramine-containg foods

    • MAOIs can cause you to go into a hypertensive episode, leading to a stroke

  • Milk or Milk Products

    • Antibiotics

  • Caffeine

    • Stimulant

Factors Affecting Nutrition

  • Various factors that influence individual nutrition:

    • Lifespan considerations (age-related nutritional needs).

    • Cultural and ethnic backgrounds.

    • Religious practices.

    • Medications and therapy effects.

    • Economics

      • Affording nutritious food (High nutrient food is more $$$)

      • Markets are trash in certain places (Food desert)

    • Personal preferences and lifestyle choices.

      • Sedentary

      • Busy

Lifespan Considerations in Nutrition

Infants/Toddlers:

  • Breastfeeding is recommended for the first 6-12 months

  • Iron-fortified formulas

  • No Cows milk or honey before 1 year old

    • Cannot break down

  • Solid food

    • As long as they can keep their head up

  • Responsive Feeding

    • Toddlers: Let them choose how full they are (do not force food)(childhood obesity)

Adolescents:

  • High metabolic demands

  • Protein, calcium, iron, iodine, folic acid, and vitamin B needs are high

  • A large quantity of dietary intake comes from snacks

  • Body image and peer pressure may influence diet

Older Adults:

  • Slow metabolic demands

  • Reduced thirst sensation

  • GI system slows

  • Decline in taste and smell

  • Tooth loss and gum disease may make it difficult to chew

  • Increased need for calcium

Pregnancy/Lactation:

  • It is recommended to start a prenatal vitamin

  • Alcohol should not be consumed during pregnancy

    • Fetal alcohol syndrome

  • Should avoid unpasterized or raw foods

    • Listeria is a bacteria found in unpasteurized and raw foods and causes pre-term birth

Cultural & Ethnicity

African American Diets:

  • Traditional diets high in fat, cholesterol, and sodium

  • Meats are breaded and fried

Nutrition Related Health Issues

  • High Obesity rate

  • Twice as likely as whites to be diagnosed with diabetes and more likely to suffer those complications

  • More likely to have poor controlled hypertension

Hispanic/Latino Americans:

  • Traditionally low-fat, high-fiber rich in complex carbs and vegetable protein diets

  • Pork, goat, and poultry are the most used animal proteins

Nutrition Related Health Issues

  • Lower scores for whole grains, milk, and oils

  • Increases in eating out, fast food, salty snacks, etc.

    • Higher fat and sodium intake and decrease in diet quality

  • High obesity rate

  • Diabetes is one of the leading causes of death

Religious Dietary Practices

Orthodox Judaism

  • Pork is prohibited

  • Fish (no shellfish)

  • Meat and dairy products cannot be eaten or served on the same plate

  • Fasting

Islam

  • Pork or pork products are prohibited

  • Alcohol is prohibited

  • Fasting

Hinduism

  • Beef is prohibited

  • All other meat and fish restricted or avoided

  • Alcohol is avoided

  • Fasting

Therapeutic Diets

  • Normal or “House-diet”

  • NPO

  • Modified Consistency diets

    • Clear liquid

    • Pureed

    • Mechanically altered

  • Fat-resrticed

  • Sodium-restricted

  • Renal

Modified Consistency Diets

Liquid Diets

  • Clear liquid

    • Requires minimal GI effort and provides fluid to prevent dehydration

    • Food included: Clear broth, tea, coffee, clear fruit juices (apple, cranberry, grape), popsicles, carbonated drinks, gelatin

    • Indicated for: Prep for bowel surgery or lower endoscopy; Initial post-op diet

  • Full liquid

Pureed Diet

  • All foods are allowed- blended

  • Indicated for: Chewing or swallowing difficulties; oral or facial surgery

Mechanically altered Diet

  • A regular diet with modifications for texture

  • Foods are chopped, ground, mashed or soft

  • Indicated for: Chewing and swallowing difficulties

Fat-Restricted Diet

  • Used to reduce fat levels

  • Indicated for Liver, gallbladder, pancreas, and cardiovascular diseases

Sodium-Restricted Diet(DASH)

  • Limits salt intake

  • Indicated for: HTN, Heart failure (acute/chronic), renal disease, liver disease

Renal Diet

  • Reduce workload on kidneys to delay or prevent further damage; control accumulation of uremic toxins

  • Low in sodium, phosphorus, and protein

  • Indicated for: Nephrotic syndrome; chronic kidney disease; diabetic kidney disease

Enteral Nutrition (Tube Feeding)

The GI system HAS to work (can cause aspiration)

Assess bowel sounds

  • Swallowing issues, throat blockage, mechanical reasons

Short Term

  • Nasogastric (NG) tube

    • To stomach

  • Nasointestinal (NI) tube

    • Nasoduodenal (ND)

      • Specific place in intestine

    • Nasojejunal (NJ)

Long Term

  • Gastrotomy

    • Where it is going

  • Jejunostomy

Nasally Placed Feeding Tube

Nasogastric (NG) tube

  • Short-term use (<4 weeks)

  • Used for:

    • Enteral Nutrition

    • Gastric decompression

      • Emptying stomach

    • Gastric lavage

      • Cleaning area to see where bleeding is coming from

    • Administration of Medications

  • Contraindications:

    • Facial trauma or surgery

    • Esophogeal stricture

      • Narrowing of esophagus

    • Esophageal varices

      • Blockage of airway

Stomal Feeding Tube

Gastrostomy (G) Tube/ Jejumostomy (J) Tube

  • Long Term use (> 6 weeks)

  • Placement:

    • Percutaneous

      • Percutaneous endoscopic gastrostomy (PEG)

      • Percutaneous endoscopic jejunostomy (PEJ)

    • Surgical

      • Open

      • Laparoscopically

  • Contraindications:

    • Ascites (bloating)

    • Peritonitis (infection)

    • Severe coagulopathy (increased risk of bleeding)

Confirming Tube Placement

  • Radiographic (Xray)

  • Measure Tube length and marking

  • Test Aspirate: Pull back on the syringe, withdraw stomach content, and place it in a medicine cup. Then, use a pH strip. (should be less than or equal to 5)

    • pH

    • Biochemical Markers

  • Capnography

  • Ultrasound: Not always correct

  • Visualization technology

Delivery of Enteral Nutrition

  • Open Tube System

    • The formula must be transferred from the original packaging to the feeding container.

    • Hang time is about 4 hours for unsterilized formulas and 8-12 for sterilized formulas.

  • Closed Tube System

    • Formula prepackaged in a ready-to-use container

Administration Methods of Enteral Nutrition

  • Continuous

  • Cyclic

  • Intermittent

  • Bolus

Enteral Feeding Formulas

  • Standard Formulas

    • Daily recommended guidelines of nutritional intake

    • Ex. Ensure

  • Elemental Formulas

    • Have specific building blocks

    • Ex. specific amino acid

  • Specialized Formulas

    • Specific for people with diabetes or kidney disease

    • Ex. Minimal protein or vegan

  • Immune-enhancing formulas

    • For the immunocompromised

Nursing Considerations for Nutrition

Promote Patient Safety

  • Safety Considerations for Enteral Feeding

    • Gut works

    • Tube in the right place

    • Check residual

    • Bed positioning (make sure they are at least 45 degrees (semifowler))

    • The tube is patent (going in correctly) (Flush the tube)

    • Change the bag according to the policy

    • Placement of tube feed

  • Safety Considerations for PO Feeding

    • Swallowing/chewing

    • Not talking while eating

    • Semifowler position

    • Small bites

    • Minimize distraction

    • Monitor

    • Everything is close/ fall risk

    • Dysphasia

      • Coughing

      • storing food in cheeks

      • Drooling

Monitor for Complications

Enteral Feeding

  • Aspiration

  • Clogged Tube

  • Nasal Erosion

  • GI symptoms

  • Dislodgement

  • Stoma Infection

PO Feeding

  • Choking

  • Allergies

  • Malnutrition

  • Obesity

Comforting Measures

Enteral Feeding

  • Oral Hygiene

  • Keep nares clean

  • Secure tube

  • Upright position

PO Feeding

  • Oral Hygiene

  • Upright position

  • Food/Tray Reachable

Exemplars

Malnutrition

  • Can be caused by disease, mental illness, depression or poverty

  • BMI <18 or >30

  • Associated with higher costs, longer stays, and increased mortality

    • Poor wound healing

    • Increased risk of infection

  • Early detection and prompt treatment are essential in preventing and managing malnutrition.

  • Screening plays an essential role in identifying malnutrition risks

  • Person-centered nutrition interventions are key

  • Signs

    • Hair falling out

    • Brittle nails

    • Edema

    • Dry skin

    • Dehydration

  • Medical Management

    • Lifestyle modifications

      • Diet (MyPlate)

      • High in nutrient foods

    • Exercise

      • 30 minutes/5 days = 150 minutes a week

    • Enteral/Parenteral Nutrition

      • If nutrition is inferior

      • TPN: Nutrition given through IV through the central line

    • Oral Supplementation

  • Nursing Process

    • Assessment

      • Mini Nutritional Assessment (MNA)

    • Planning

    • Intervention

    • Evaluation

Obesity

  • Chronic disorder that is characterized by excessive body fat and weight gain

  • BMI of 30 or more

  • Genetic predispositions and large portions of obesogenic foods contribute to the occurrence of obesity.

  • Increased risk of mortality

  • Several chronic conditions linked with obesity

  • Over 600 million adults are considered obese

  • Medical Management

    • Lifestyle Modifications

      • Exercise: PCC (realistic)

      • Dietary changes

    • Pharmacologic Treatment

      • Ozempic (treats diabetes)

    • Surgical Interventions

      • Bypass

      • Biaritric Surgery

      • Gastric Band

  • Applying the Clinical Judgement Model