Chapter 24: Basic Nutrition
Fundamental Principles of Nutrition
Definition of Nutrition: The process of taking in food and using it for the body's needs. This process involves four primary stages:
Ingestion: Taking food into the digestive tract.
Digestion: Breaking down food into smaller components.
Absorption: Moving nutrients from the digestive tract into the bloodstream.
Metabolism: Using the absorbed nutrients for energy and biological processes.
Energy Measurement: The energy provided by food is measured in units called kilocalories, which are more commonly referred to as calories.
Nutrients: Food is broken down into essential elements known as nutrients, which provide energy and ensure the body functions properly.
The Six Essential Nutrients
1. Carbohydrates
Function: Carbohydrates serve as the source of the most basic type of fuel, known as glucose.
Types:
Simple sugars.
Complex carbohydrates (starches), which must be broken down into simple sugars before use.
Energy Content: Each gram of carbohydrate provides .
Storage: Extra carbohydrates are stored in the liver as fuel (glycogen) or converted to fat and stored elsewhere in the body.
Prevalence: They are the basis of many diets because they are easily accessible and inexpensive.
2. Proteins
Sources: Found in milk, cheese, meat, poultry, fish, eggs, nuts, dried peas, and beans.
Components: Proteins contain amino acids, which are small molecules that serve as the building blocks of all cells.
Function: Help the body rebuild tissue that breaks down during normal use and grow new tissue following illness or injury.
Energy Content: Each gram of protein provides .
3. Lipids (Fats)
Sources: Butter, cooking oils, whole milk, cheese, meat, egg yolks, nuts, shortening, and lard.
Function:
Necessary for the body to use fat-soluble vitamins (, , , and ).
Protect organs and assist in thermal regulation (staying warm).
Improve food taste and satisfy appetite for longer periods.
Digestion: Lipids take longer to digest than most other food sources.
Energy Content: Each gram of fat provides .
4. Vitamins
Water-Soluble Vitamins: Include Vitamin and the vitamins.
They dissolve in water and are absorbed directly from the digestive tract into the bloodstream.
The body cannot store these; they are not easily retained.
Fat-Soluble Vitamins: Include Vitamins , , , and .
These are absorbed and stored in the body's fat.
They are not easily passed from the body; consuming excessive amounts can be harmful.
5. Minerals
Function: Help provide structure within the body and regulate essential body processes.
Examples: Calcium, phosphorus, iron, iodine, sodium, potassium, and magnesium.
6. Water
Body Composition: Approximately to of total body weight is water; every cell contains water.
Functions:
Forms the basis for fluid that dissolves and circulates nutrients.
Transports waste products out of the body.
Cools the body through evaporation.
Keeps mucous membranes moist.
Forms the basis of fluid that allows joints to move smoothly.
Tools for a Balanced Diet
Definition: A diet providing balanced amounts of all essential nutrients.
MyPlate: Designed to remind people to eat healthfully by using a place-setting illustration for food groups:
Grains.
Vegetables.
Fruits.
Milk.
Meat and beans.
General Suggestions:
Build a healthy plate.
Reduce foods high in solid fats, added sugars, and salt.
Match calorie intake to activity levels.
Maintain physical activity.
Food Labels: A tool for planning diets. Labels on packaged food must include:
Nutritional value and % daily value.
Approximate serving size.
Related health claims.
Calorie count.
Note: Healthcare workers should help residents choose foods lower in calories, saturated fat, trans fat, and sodium.
Nutritional Needs of Older Adults
Caloric Needs: Generally require decreased calories compared to younger adults.
Protein Needs: Require an increased or equal amount of protein to maintain tissues.
Fluid Intake: Requires an increased focus on fluids to prevent dehydration.
Food Form: Foods may need to be softer or easier to chew due to age-related changes.
OBRA Requirements for Meals
Meals must meet individual nutritional needs.
Food must be served at the proper temperature.
Food must be appealing to look at and seasoned to the individual resident’s preference.
Special diets (e.g., religious diets) must be provided.
Dining in the company of others is recommended.
Residents in rehabilitation learning independent eating must have a private area to practice.
Factors Influencing Food Choices and Eating Habits
Physical/Cognitive Factors: Appetite, dysphagia (swallowing problems), disability, and impaired cognitive function.
Socioeconomic Factors: Finances, kitchen skills, and individual taste.
Cultural Factors: Religion, culture, and geography.
Assessment: The nurse completes a dietary assessment to determine resident habits and preferences, involving the dietitian and nursing assistant.
Types of Special Diets
Regular "House" Diet: No restrictions.
Clear Liquid Diet: Includes only liquids you can see through.
Full Liquid Diet: Includes all liquids.
Mechanical Pureed Diet (IDDSI): Food is blended to a smooth consistency.
Low Cholesterol Diet: Limited fats to manage heart health.
Sodium-Restricted Diet: Limited salt; use of salt alternatives.
Carbohydrate-Controlled Diet: Specifically for patients with diabetes.
Nutritional Supplements: Used to supply extra calories or protein in addition to the diet.
Procedures for Mealtime Assistance
Preparation
Allow time for early morning or afternoon care.
Assist with toileting and basic hygiene (clean, fresh mouth).
Assist the person to the dining room and position them comfortably.
Ensure a pleasant environment and stimulate appetite with small portions of favorite foods.
Serving Meals
Serve meals immediately upon delivery to maintain temperature.
Identity Check: Match the name on the tray to the resident and verify the correct diet.
Use clothing protectors (cloth or paper) as needed.
Perform hand hygiene between residents.
Wear gloves ONLY if touching the person's food with hands; gloves are unnecessary for opening cartons or holding a spoon.
Assistance Techniques
Help open containers (milk, juice), remove silverware, butter bread, and cut meat.
Visual Impairment: Describe the food and use the "clock face" reference (e.g., "the peas are at 3 o'clock") to help them locate items.
Ensure assistive devices are available.
Feeding Dependent Residents
Involve the person in the process and sit down to talk to them.
Utensil Use: Use a spoon, not a fork. Fill the spoon only about one-third full.
Pacing: Give the person time to chew and swallow; never rush them.
Fluid Intake: Offer liquids frequently between bites.
Offer choices and encourage consumption of protein and vegetables.
Guidelines for Thickened Liquids
Consistency Levels: Nectar, Honey, and Pudding consistency.
Why Thickened?: To prevent aspiration and choking in residents with swallowing difficulties.
Technique:
Use a "sprinkle and stir" technique for better dissolution.
Allow the liquid to sit for to to reach the full effect.
Thicken all liquids, including soup.
Critical Restrictions:
Add condiments before adding thickener.
Do NOT add ice (it thins the liquid as it melts).
Do NOT give foods that melt at room temperature (e.g., ice cream).
Do NOT provide a bedside water pitcher; water must be thickened first.
Staff must offer thickened beverages frequently throughout the day.
Monitoring: Check hot beverages periodically as they may thicken further as they cool.
Alternate Methods of Nutrition
Intravenous (IV) Therapy
Content: Provides fluids, glucose, vitamins, minerals, medication, or blood.
Note: It is not considered complete nutrition.
Nurse Notifications: Tell the nurse if the tubing disconnects, the bag is empty, fluid isn't dripping, blood backs up, or the site shows pain, redness, or swelling. Never silence or turn off pumps.
Enteral Nutrition
Methods: Nasogastric (NG), nasointestinal, gastrostomy (G-tube), jejunostomy (J-tube), or percutaneous endoscopic gastrostomy (PEG) tubes.
Nurse Notifications: Signal the nurse for nausea, bloating, pain, coughing, gagging, vomiting, abdominal distention, diarrhea, or drainage/redness at the site.
Positioning: The head of the bed must remain elevated above .
Total Parenteral Nutrition (TPN)
Also known as hyperalimentation.
Utilizes a larger tube inserted into a large vein near the heart to allow for the delivery of proteins and fats.
Fluid Balance, Dehydration, and Edema
Fluid Balance: Occurs when fluid intake equals fluid output.
Dehydration: Too little fluid in the body.
Causes: Diarrhea, vomiting, hemorrhage, severe burns, diaphoresis (excessive sweating), or inadequate drinking.
Edema: Too much fluid in the body (swelling).
Causes: Kidney disease or heart disease.
Treatment: Fluid restriction or medication.
NPO Status (Nils Per Os): Nothing by mouth. This means no water, ice, food, candy, or gum. Frequent oral care is required. Some may be NPO with specific exceptions (e.g., "sips and chips" or "NPO with meds").
Measuring and Recording Intake and Output (I&O)
Conversion: .
Intake includes: All fluids drank, foods liquid at room temp, IV fluids, and enteral/TPN feedings (nurses typically handle IV/Enteral/TPN recording).
Output includes: Urine (catheters), vomit, blood, wound drainage, and diarrhea.
Procedure:
Record at the end of each shift or every .
Calculate intake by subtracting leftover fluid from the starting amount.
Inform the nurse if a resident eats less than of their meal.
Always wear gloves when measuring output.
Questions & Discussion
Question: Which nutrient helps regulate a body process?
Answer: Water. Water, minerals, and vitamins help regulate body processes, while carbohydrates, proteins, and fats supply energy.
Question: When helping someone eat, is it best to wait until all solid food is eaten before offering a drink?
Answer: False. Offer liquids frequently between bites.
Question: A resident drank an cup of coffee. What is recorded on the I&O sheet?
Calculation: .
Answer: .