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