sf foundation module 5

Nutrition

Module 6

Reading Assignment

  • Moreno-Donnelly, L. (2021). Timby’s Fundamental Nursing Skills and Concepts (12th ed.). Philadelphia: Lippincott Williams & Wilkins. Chapter 15 & 16

Behavioral Objectives

  • Name three functions of food.

  • List the essential nutrients and their functions.

  • Identify three sources of each essential nutrient.

  • Differentiate between macro and micro minerals.

  • Compare fat-soluble and water-soluble vitamins.

  • Contrast the nutritional needs during the life cycle.

  • Describe the need for water in one’s diet.

  • Explain how cultural background influences dietary habits.

  • Describe 8 therapeutic diets.

Metabolism

  • Definition: Metabolism refers to all the physical and chemical processes by which life is maintained.

Types of Metabolism

  • Catabolism:

    • Definition: The process of breaking down substances into simpler molecules.

    • Includes digestion of food and oxidation of nutrient molecules for energy.

  • Anabolism:

    • Definition: The process of building simpler compounds into more complex substances needed by the body.

Energy Requirements

  • Metabolic Rate: The rate at which energy is used by the body.

Basal Metabolic Rate (BMR)

  • Definition: The rate at which energy is released to maintain life functions while the body is at rest.

  • Influencing factors:

    • Age

    • Height and weight

    • Activity level

    • Overall health status

Daily Energy Requirements

  • Women: 1,600 - 2,400 kcal/day

  • Men: 2,000 - 3,000 kcal/day

  • Importance of thyroid hormones in regulating BMR.

  • Calorie: A unit of energy measurement in food.

BMI - Body Mass Index

  • Definition: A screening tool that estimates body fat percentage using height and weight.

  • Limitations:

    • Cannot differentiate between muscle, bone, and fat loss.

    • Does not account for age, sex, or fat distribution.

BMI Chart

  • Categories:

    • Underweight: < 18.5

    • Healthy: 18.5 - 24.9

    • Overweight: 25 - 29.9

    • Obese: 30 - 39.9

    • Severely Obese: > 40

Nutrients

Macronutrients

  • Definition: Nutrients needed in large amounts that support growth, maintenance, and repair of body tissues.

  • Types:

    • Carbohydrates

    • Proteins

    • Lipids (Fats)

    • Water

Functions of Macronutrients

  • Growth: Development and reproduction.

  • Maintenance: Immunity and energy requirements.

  • Repair: Tissue repair post injury.

Micronutrients

  • Definition: Nutrients needed in small amounts that do not provide energy but play roles in immunity, bone health, and metabolism.

  • Types:

    • Vitamins: Essential organic compounds.

    • Minerals: Inorganic elements essential for various bodily functions.

Functions of Micronutrients

  • Water-soluble Vitamins: (B & C)

  • Fat-soluble Vitamins: (A, D, E, K)

  • Macro Minerals: (Calcium, Phosphorus, Magnesium)

  • Trace Minerals: (Iron, Zinc)

The Digestive System

Components

  • Gastrointestinal (GI) Tract: Mouth, pharynx, esophagus, stomach, small intestines, large intestines, rectum, anus.

  • Accessory Glands: Salivary glands, liver, gallbladder, pancreas.

Functions of Carbohydrates

  • Energy Source: Primary source of fuel for the body.

  • Spare Protein: Prevents breakdown of muscle protein for energy.

  • Prevent Ketosis: Promote use of glucose instead of fats for energy.

  • Cognitive Function: Glucose enhances memory and learning.

  • Promote Peristalsis: Fiber helps bulk stools and aids digestion.

  • Lower Cholesterol: Soluble fiber binds cholesterol in the digestive tract.

  • Energy Content: 4 kcal/1 gram of carbohydrates.

Classification of Carbohydrates

  • Monosaccharides: Glucose, fructose.

  • Disaccharides: Sucrose, lactose.

  • Polysaccharides: Starch.

Simple vs. Complex Carbohydrates

  • Simple Carbohydrates:

    • Sources: Sweets, refined grains.

    • Characteristics: Easily digested, causes sugar spikes, should be paired with protein/fiber.

  • Complex Carbohydrates:

    • Sources: Vegetables, whole grains.

    • Characteristics: Digested slowly, sustained energy release, high in dietary fiber.

Storage of Carbohydrates

  • Glycogen: Stored in liver and skeletal muscles.

  • Adipose Tissue: Excess carbohydrates converted to fat for long-term storage.

Digestion of Carbohydrates

  • Begins in the mouth with salivary amylase, continues in the small intestines with pancreatic amylase.

  • Insulin facilitates diffusion of glucose into the cells.

Clinical Concerns

  • Blood glucose levels affected by the intake of simple vs. complex carbohydrates.

Functions of Proteins

  • Structural Functions: Provide structure to cells (Keratin, collagen).

  • Maintaining Functions: Maintain and build cells, regulate body processes, and provide energy in emergencies.

  • Energy Content: 4 kcal/1 gram of protein.

Amino Acids

  • Basic Building Blocks: 20 different amino acids.

  • Essential Amino Acids: 9 must be obtained from food.

  • Non-essential Amino Acids: 11 can be synthesized by the body.

Digestion of Proteins

  • Begins in the stomach with action of hydrochloric acid (HCl) and pepsin, continues in the small intestines.

  • End product: amino acids.

Types of Proteins

  • Complete Proteins: Contains all 9 essential amino acids, usually from animal sources (e.g., fish, meat, eggs).

  • Incomplete Proteins: Missing one or more essential amino acids, typically from plant sources (e.g., beans, grains).

  • Complementation: Combining two incomplete proteins to form a complete protein.

Clinical Applications of Proteins

  • Blood Albumin Levels: Hypoalbuminemia results from decreased protein, leading to fluid imbalance and ascites.

Protein Balance

  • Negative Protein Balance: Catabolism exceeds anabolism, leading to malnutrition and muscle loss.

  • Positive Protein Balance: Occurs when protein synthesis exceeds breakdown, especially during growth.

Lipids/Fats

  • Functions: Fuel supply, long-term energy storage, insulation, protection of organs, lubrication, and facilitating vitamin absorption.

  • Energy Content: 9 kcal/1 gram.

Types of Lipids/Fats

  • Saturated Fatty Acids: Solid at room temperature, primarily from animal sources (e.g., butter, red meat).

  • Unsaturated Fatty Acids: Liquid at room temperature, mostly from plant sources (e.g., oils, nuts).

  • Trans-Fatty Acids: Hydrogenated fats deemed unsafe.

Digestion of Fats

  • Begins with emulsification by bile salts in the small intestine, followed by pancreatic lipase action.

Functions of Cholesterol

  • Component of bile salts, cell membranes, brain tissue, and necessary for steroid hormone production.

Clinical Concerns Related to Fats

  • Importance of lipid profiles in assessing cholesterol levels:

    • HDL: Good cholesterol, helps transport excess lipids to the liver.

    • LDL: Bad cholesterol, leads to deposition in blood vessels.

    • Triglycerides: Key component in fat storage.

Water

  • Body Composition: 60-70% water; infants have about 75% water content which decreases with age.

Functions of Water

  • Gives cells shape, maintains blood volume and pressure, regulates body temperature, transports nutrients and wastes, participates in metabolic reactions.

Dietary Sources of Water

  • Beverages, fruits, vegetables, soups.

Water Loss

  • Sensible Losses: Urine, feces, vomit, wound drainage.

  • Insensible Losses: Sweating and respiration.

Clinical Concerns

  • Dehydration: Symptoms include dry mucous membranes and electrolyte imbalance.

Vitamins

  • Definition: Organic substances needed in small quantities, functioning as components of enzymes or metabolic processes.

  • Fat-Soluble Vitamins: Stored in body reserves (A, D, E, K).

  • Water-Soluble Vitamins: Excreted via fluids; require daily intake (B vitamins, C).

Functions and Sources of Vitamins

  • Vitamin A (Retinol): Antioxidant, epithelial tissue integrity, eye pigment, reproduction, immunity. Sources include dairy, orange fruits, and vegetables. Deficiency causes night blindness and decreased immunity.

  • Vitamin D (Calciferol): Promotes calcium and phosphorus absorption, essential for bone formation. Sources include eggs and fortified milk; deficiency leads to rickets in children and osteomalacia in adults.

  • Vitamin E (Tocopherol): Antioxidant, protects cell membranes. Sources include seeds and nuts; deficiency leads to increased RBC destruction.

  • Vitamin K: Aids in blood clotting and bone formation; obtained from green leafy vegetables and bacteria in the digestive tract.

Water-Soluble Vitamins

  • Vitamin B1 (Thiamine): Supports enzyme synthesis and oxidation of nutrients. Sources: grains and legumes; deficiency causes weakness and heart problems.

  • Vitamin B2 (Riboflavin): Aids in enzyme synthesis; sources include dairy and leafy greens; deficiency leads to fatigue and GI issues.

  • Vitamin B3 (Niacin): Helps lower cholesterol; sources include legumes and meats; deficiency can result in pellagra.

  • Vitamin B6 (Pyridoxine): Important for protein metabolism; deficiency can lead to dermatitis and seizures.

  • Vitamin B12 (Cyanocobalamin): Critical for hemoglobin synthesis; from animal products; deficiency results in pernicious anemia.

  • Folic Acid: Essential for amino acid metabolism and DNA synthesis; deficiency can lead to neural tube defects.

  • Vitamin C (Ascorbic Acid): Important for immunity and collagen synthesis; deficiency causes scurvy.

Minerals

  • Definition: Elements necessary for proper bodily functions.

  • Macro Minerals: Include Calcium, Phosphorus, Sodium, Potassium, Magnesium.

  • Micro Minerals: Include Iron, Iodine, Fluoride, Chromium, Zinc.

Functions and Sources of Macro Minerals

  • Calcium (Ca): Key for bone and teeth formation, muscle contraction, and nerve conduction. Sources include dairy products; deficiency leads to rickets and osteoporosis.

  • Phosphorus (P): Important for bone formation and energy metabolism (found in ATP). Sources: meats and grains; deficiency results in osteoporosis.

  • Sodium (Na): Crucial for nerve function and fluid balance; sources include processed foods; deficiency leads to weakness and dehydration.

Functions and Sources of Micro Minerals

  • Iron (Fe): Vital for oxygen transport in hemoglobin; sources include fortified cereals and meat; deficiency results in anemia.

  • Iodine (I): Necessary for thyroid hormone production; sources include seafood; deficiency leads to hypothyroidism.

  • Zinc (Zn): Supports metabolism and immune function; deficiency can result in alopecia.

Nutritional Guidelines

  • Established to promote health and adjusted by factors such as age, gender, pregnancy, lactation, and disease process.

General Recommendations

  • Emphasize whole grains, fruits, vegetables, and low-fat dairy.

  • Include lean meats and limited intake of fats, oils, and sweets.

Addressing Nutritional Issues

Nursing Process

  • Steps involved:

    • Assessment

    • Diagnosis

    • Planning

    • Implementation

    • Evaluation

Nutritional Status Assessment

  • Visual Assessment: Observe general appearance, skin, eyes, gums, teeth, weight, posture, abdomen.

  • Interview: Evaluate cultural background and dietary preferences.

  • Measurements: Include height, weight, and blood tests.

Diagnosis Examples

  • Imbalanced nutrition, impaired swallowing, risk for unstable blood glucose levels.

Planning

  • Identify priorities and set goals with anticipated interventions.

Implementation

  • Interventions and dietary guidelines for clients.

Evaluation

  • Assess the effectiveness of interventions.

Regular Diet

  • Provides approximately 2,000 calories/day designed to meet specific nutritional needs based on age and cultural considerations.

Dietary Guidelines

  • Promote balanced nutrition with a focus on vegetables, whole grains, fruits, and low-fat dairy.

Nutritional Modifications by Life Stage

  • Infants (birth-1 yr): Require high calorie intake, recommended exclusive breastfeeding for first 6 months.

  • Childhood (1 yr – adolescence): Encourage variety and good dietary habits.

  • Adolescents: Require higher calcium, iron, protein, and calories due to rapid growth.

  • Adults and Older Adults: Regular diet; older adults are at risk for undernutrition and deficiencies in B12, D, calcium, and fiber.

Liquid Diets

Types of Liquid Diets

  • Clear Liquids: Easily digested (gelatin, broth) for hydration; inadequate for complete nutrition.

  • Full Liquids: Includes milk and purified foods but does not fully meet nutrition standards.

Modifications by Consistency

  • Pureed: Foods processed to smooth consistency.

  • Mechanically Soft: For clients with chewing difficulties, food cooked to soft texture.

Disease-based Modifications

  • Diabetic Diet: Limit simple sugars, smaller meals to prevent hypoglycemia.

  • Renal/Liver Diet: Sodium restrictions, controlled protein, potassium, and phosphorus intake.

  • Cardiovascular Diet: Low sodium, control cholesterol, improve insulin sensitivity, promote weight management.

  • GI Issues: High fiber diet for constipation; low fiber diet recommended for conditions like IBS.

  • Wound Healing: High protein diet for tissue repair.

  • Lactose Intolerance: Lactose-free products recommended, including aged cheeses and plant-based alternatives.