Nutrition

NUTRITION

Introduction

• Presenter: Dr. Chaney-Grant DNP MSN Ed, RN

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• Copyright: © 2019 Wolters Kluwer • All Rights Reserved

• Content is for learning purposes; it is the student's responsibility to take notes and read textbook chapters as outlined in the syllabus. PowerPoints should not replace ethical study practices.

Learning Objectives

1. Describe Essential Nutrients: Identify the six classes of nutrients and their significance in health.

2. Recognize Risk Factors for Poor Nutrition: Identify factors that contribute to malnutrition and poor dietary habits.

3. Explain Nutrition Across the Life Span: Understand how nutritional needs change from infancy to older adulthood.

4. Conduct a Basic Nutritional Assessment: Identify key components of assessing a patient’s nutritional status.

5. Implement Nursing Interventions for Nutrition: Assist patients in meeting their nutritional goals, including enteral and parenteral nutrition.

6. Develop a Nutrition-Focused Care Plan: Plan, implement, and evaluate nursing care related to nutritional health.

Six Classes of Nutrients

• Nutrients that Supply Energy:

  • Carbohydrates

  • Types: Sugars and starches, classified into simple and complex.

  • Metabolism: Converted to glucose for transport through blood. Cells oxidize glucose to provide energy, producing carbon dioxide and water.

  • Primary function: Provide energy.

  • Energy content: 1 gram of carbohydrates = 4 calories.

  • Proteins

  • Role: Maintain body tissues, repair wear and tear, support growth of new tissues.

  • Recommended intake: 10-35% of total caloric intake.

  • Importance for wound healing: Lack of protein can cause poor wound healing and edema.

  • Energy content: 1 gram of protein = 9 calories.

  • Lipids (Fats)

  • Characteristics: Insoluble in water and blood; 95% of dietary lipids are triglycerides.

  • Fatty acids: Saturated (raise cholesterol levels) and unsaturated (lower cholesterol levels).

  • Source: Most animal fats are saturated; most vegetable fats are unsaturated.

  • Energy content: Fats are the most concentrated source of energy, providing about 9 calories per gram.

Energy and Its Requirements

• Kilocalories: The body requires energy from kilocalories in food, supplied primarily by carbohydrates, proteins, and fats.

• Role of vitamins and minerals: Support metabolism but do not contribute calories.

• Basal Metabolic Rate (BMR): Energy needed for essential functions (temperature regulation, muscle tone, organ function).

• Factors affecting energy needs: Age, body mass, gender, illness, activity levels, and thyroid function. Metabolism influenced by pregnancy, lactation, and health conditions.

Vitamins and Minerals

• Vitamins: Essential for various bodily functions.

  • Vitamin D: Sources include foods, supplements, and sunlight; regulates calcium and supports neuromuscular and immune functions.

  • Vitamin A: Benefits include cancer prevention, immune support, improved vision, bone strength, delay of aging signs, and acne reduction.

• Minerals: Include calcium, iron, magnesium, potassium, zinc; promote cell growth and reduce inflammation.

Water

• Makes up 50% to 60% of an adult's body weight.

• Distribution: Two-thirds are in intracellular fluid (ICF) and one-third in extracellular fluid (ECF, includes plasma and interstitial fluid).

• Function: Serves as a solvent; essential for digestion, absorption, circulation, and excretion, aiding all chemical reactions in the body.

• Hydration: Adequate intake crucial; infants need a higher proportion relative to body weight compared to adults.

Digestion

• Begins in the mouth (salivary amylase starts carbohydrate breakdown).

• Small Intestine: Most digestion and nutrient absorption occur; enzymes from pancreas and bile from liver assist.

• Stomach: Mixes food with gastric juices, beginning protein digestion.

• Large Intestine: Absorbs water and electrolytes, forms solid waste.

• Energy & Fat Guidelines:

  • Limit saturated fat to less than 10% of total daily calories.

  • Keep trans fat intake low.

  • Choose unsaturated fats (e.g., olive oil, avocados, nuts, fish) for heart health.

Developmental Considerations for Nutritional Needs

• Infancy:

  • Breastfeeding: Recommended exclusively for first 6 months; benefits include fewer infections, easier digestion, and reduced food allergy risk.

  • Formula: Regular cow's milk should not be given during the first year.

  • Solid Foods: Introduce one food at a time (every 4–7 days) to detect allergies.

• Adolescence:

  • Increased energy and protein needs due to rapid growth and metabolic demand.

  • Importance of calcium and iron, especially for females.

  • Higher risk for eating disorders linked to body image concerns.

• Young & Middle Adulthood:

  • Energy needs stabilize; shift focus to maintenance and repair.

  • Emphasis on balanced nutrition and physical activity to prevent chronic diseases.

• Older Adults:

  • Decreased energy needs due to slowed metabolic rate and age-related appetite/taste changes.

  • Increased nutritional needs during pregnancy with considerations for GI changes and lactation requirements.

Factors Affecting Food Habits

• Physiological and Physical Factors: Development stage, health state, medications.

• Socioeconomic Factors: Economic access to grocery stores, food costs, advertising, and environment impact obesity.

• Cultural Factors: Diversity, religious dietary restrictions (e.g., no pork), traditions, household education, politics, social status, and food ideology.

Negative Influences on Intake

• Decreased Appetite: Related to systemic or local disease, including disorders like anorexia nervosa, leading to weight loss and muscle wasting.

• Cachexia: Significant loss of body mass and appetite, common in conditions like cancer, HIV, and severe malnutrition.

Risk Factors for Poor Nutritional Status

1. Gender Differences:

   • Women typically require more iron during reproductive years.

   • Men generally have higher caloric and protein needs due to greater muscle mass.

2. Physiological and Health-Related Factors:

   • Increased metabolic needs due to conditions like burns or surgeries.

   • Oral health issues limiting food variety and intake.

   • Mobility issues affecting energy balance and appetite regulation.

3. Substance Use:

   • Alcohol Abuse: Affects nutrient metabolism, intestinal damage, absorption.

   • Medication Effects: Certain drugs alter GI motility or nutrient absorption.

   • Supplement Misuse: Excessive supplements may interact negatively with medications.

Components of Nutritional Assessment

• History Taking: Nutritional diary collection.

• Physical Assessments:

  • Anthropometric Measurements: Weight/height, BMI, midarm circumference, triceps skinfold measurements.

  • Dysphagia monitoring for aspiration risk; oral clearance issues.

Body Mass Index (BMI)

• Definition: A calculated measure of body weight relative to height, categorizing into underweight, healthy, overweight, and obesity ranges.

• BMI Calculation:

  • Formula (metric): $BMI = rac{ ext{weight (kg)}}{ ext{height (m)}^2}$

  • Formula (imperial): $BMI = rac{ ext{weight (lbs)} imes 703}{ ext{height (inches)} imes ext{height (inches)}}$

• Example Calculation: For a person weighing 120 lbs and standing 5 ft 3 in (63 in):
  $BMI = rac{120 imes 703}{63 imes 63} = rac{84,360}{3969} = 21.3$ (Healthy weight range).

WHO BMI Categories

• Categories:

  • < 16.0: Severely Underweight

  • 16.0 – 18.4: Underweight

  • 18.5 – 24.9: Normal

  • 25.0 – 29.9: Overweight

  • 30.0 – 34.9: Moderately Obese

  • 35.0 – 39.9: Severely Obese

  • > 40.0: Morbidly Obese

Laboratory Data

• Key Laboratory Measurements:

  • Hemoglobin (normal = 12–18 g/dL): Decreased levels → anemia; increased levels → dehydration.

  • Hematocrit (normal = 40–50%): Decreased levels → anemia; increased levels → dehydration.

  • Serum Albumin (normal = 3.5–5.5 g/dL): Decreased levels → malnutrition/protein depletion; increased levels → liver disease.

  • Prealbumin (normal = 19-38 mg/dL): Decreased levels → protein depletion; increased levels → indicative of acute malnutrition.

  • Transferrin (normal = 240–480 mg/dL): Decreased levels → anemia/protein deficiency; increased levels → iron deficiency.

Dietary Data/Assessment Tools

• Methodologies:

  • 24-hour Recall: Patient recalls past 24 hours of food intake.

  • Food Diaries/Calorie Counts: Periodic collection of food intake data.

  • Food Frequency Records: Frequency of certain food consumption.

  • Diet History: Comprehensive assessment combining the above to establish nutritional goals.

Nursing Analysis/Diagnosis for Nutritional Status

• Common Diagnoses:

  • Risk for aspiration.

  • Diarrhea.

  • Deficient knowledge.

  • Readiness for enhanced nutrition.

  • Feeding self-care deficit.

  • Impaired swallowing.

  • Imbalanced nutrition: less than body requirements.

The MyPlate Food Guide

• Categories:

  • Fruits

  • Vegetables

  • Grains

  • Protein

  • Dairy

• Website: Visit MyPlate.gov for more information.

Nursing Interventions

• Collaboration with dietitians for nutritional education is essential.

• Teaching food safety practices including proper food handling and hygiene.

• Monitor the patient's dietary progression (e.g., from NPO to clear liquids).

• Stimulate appetite by serving frequent, aesthetically appealing meals and respecting food preferences.

• Assist with feeding, maintaining patient dignity and comfort. Ensure patients are positioned properly, and provide guidance for visually impaired patients using meal aids.

Therapeutic Diets

1. Clear Liquid Diet:

   • Composed of clear fluids/foods that become fluid at body temperature.

   • Low residue and minimal digestion required; used pre-surgical or for gastrointestinal issues.

   • Examples include broth, clear juices, gelatin, etc.

2. Puréed Diet:

   • Blenderized foods; allows all food types.

   • Used for those with swallowing difficulties.

3. Mechanically Altered Diet:

   • Regular diet modified for texture, excluding raw fruits/vegetables and including only soft options.

   • Indications include swallowing difficulties or post-surgery needs.

Nutritional Support

Short-Term Nutritional Support

• Indication: For patients who are NPO and can’t tolerate extended periods without food.

• Method: Enteral feeding via nasogastric or nasointestinal routes.

• Verification: Confirm placement before administering anything, using techniques like aspirate pH checks, carbon dioxide monitoring, and radiographic examination.

Long-Term Nutritional Support

• Methods: Enterostomal tube placement (gastrostomy or jejunostomy) for patients requiring long-term nutrition.

• Gastrostomy: Preferred for comatose patients; can be placed via PEG.

• Monitoring: High residual volume may indicate aspiration risk; flushing protocols for immunocompromised patients.

Parenteral Nutrition (PN)

Total Parenteral Nutrition (TPN) & Peripheral Parenteral Nutrition (PPN)

• Indication: For patients unable to digest or absorb enteral nutrition or in states of severe physiological stress.

• Composition: Administered intravenously, providing nutrients through central or peripheral lines.

• Signs of Intolerance: High gas residuals, nausea, cramping, vomiting, diarrhea.

Complications with TPN

• Potential Issues:

  • Insertion problems, infection, metabolic alterations, phlebitis, and liver/gallbladder complications.

• Monitoring: Vital signs and glucose levels every 4 hours; special care for infusion sets and bag usage (24-hour shelf life).