Nutrition, Fluids, and Electrolytes Study Notes

Fundamentals of Nutrition, Fluids, and Electrolytes

Unit IIIB Overview

  • Covers Chapters 15, 16, 29, 30, 31 from Timby's Introductory Medical-Surgical Nursing, Thirteenth Edition by Lippincott CoursePoint, taught by Professor Munoz.

Nutrition

  • USDA’s MyPlate food management system has replaced MyPyramid.

    • Comprises 5 basic food groups:

    • Protein

    • Grains

    • Fruits

    • Vegetables

    • Dairy

Nutrients

  • The six essential elements necessary for body processes are:

    • Proteins

    • Carbohydrates

    • Fats

    • Water

    • Minerals

    • Vitamins

MyPlate Food Management System

  • Visual breakdown:

    • Dairy

    • Fruits

    • Grains

    • Vegetables

    • Protein

  • Resource: ChooseMyPlate.gov

Food Label (Nutrition Facts Example)

  • Serving Size: 1/2 cup (114g)

  • Servings Per Container: 4

  • Calories: 90 (from fat: 30)

  • % Daily Value based on a 2,000 calorie diet:

    • Total Fat: 3g (5%)

    • Saturated Fat: 0g (0%)

    • Trans Fat: 0g (0%)

    • Cholesterol: 0mg (0%)

    • Sodium: 300mg (13%)

    • Total Carbohydrates: 13g (4%)

    • Dietary Fiber: 3g (12%)

    • Sugars: 3g

    • Protein: 3g

    • Vitamin A: 80%

    • Calcium: 4%

    • Vitamin C: 60%

    • Iron: 4%

Daily Value Guidelines

  • Calories (2,000/2,500 cal):

    • Total Fat: 65g/80g

    • Saturated Fat: <20g/25g

    • Cholesterol: <300mg

    • Sodium: <2400mg

    • Total Carbohydrate: 300g (375g if active)

    • Dietary Fiber: 25g (30g if active)

  • Calories per gram:

    • Fat: 9

    • Carbohydrate: 4

    • Protein: 4

Proteins

  • Essential functions of proteins include:

    • Building body tissues during growth

    • Maintenance and repair of tissues

Carbohydrates

  • Primary source of energy.

    • Energy Conversion: 1 gram = 4 kcal

    • Types of Carbohydrates:

      • Simple Carbs:

      • Complex Carbs:

Fats (Lipids)

  • Components of a lipid profile include:

    • LDL (Low Density Lipoproteins): Carry cholesterol throughout the body, depositing it in arteries (known as "bad cholesterol"). Goal: <100 mg/dl.

    • HDL (High Density Lipoproteins): Carry cholesterol to the liver for excretion (known as "good cholesterol"). Goal: >60 mg/dl.

    • Total cholesterol: Measure of all cholesterol (LDL + HDL); Goal: <200 mg/dl.

Vitamins

  • Vital for normal metabolism.

  • Highest content found in fresh foods.

    • Fat-Soluble Vitamins: A, D, E, K.

    • Water-Soluble Vitamins: B and C complex (cannot be stored in the body).

Minerals

  • Inorganic elements in all body tissues and fluids, essential for metabolism and cellular function.

    • Major Minerals: present in the body in amounts >5 grams (e.g. calcium, phosphorus, sodium, potassium, magnesium).

    • Trace Minerals: present in amounts <5 grams (e.g. iron, iodine, zinc, fluoride, copper).

Water

  • Most essential nutrient, comprises 60-70% of total body weight.

  • Daily intake recommended:

    • 6-8 eight-ounce glasses or 1500-2000 ml.

  • Water balance equation: water intake = urine output + other losses.

Fiber

  • Average adult requires 25-35 grams per day.

  • Sources include: fruits, vegetables, whole-grain foods, cereals, pasta, potatoes, rice.

Nutritional Assessment

  • Components of Nutritional Assessment:

    • Medical, family, and social history.

    • Height and weight.

    • Body Mass Index (BMI):

      • Normal: 18.5 – 24.9

      • Underweight: <18.5

      • Overweight: 25 – 29

      • Obese: ≥30

    • Signs of malnutrition, allergies, blood levels of albumin, hemoglobin, hematocrit, fats, and cholesterol.

Modified Diets for Disease

  • **Diet Types:

    • Diabetic:** Manages calories and carbohydrates.

    • Calorie-Restricted: For weight loss.

    • Sodium-Restricted: For hypertension and heart disease (reduces fluid).

    • Fat-Restricted: Lowers cholesterol or assists in weight loss.

    • Renal/Protein-Restricted: For kidney and liver diseases.

Therapeutic Diets

  • Regular Diet: No specific nutritional needs, unrestricted food selections.

  • NPO (Nil Per Os):

    • Commonly used before surgery or diagnostic studies.

    • For GI concerns.

Clear Liquid Diet

  • Composed of non-pulp liquids such as water, broth, fruit juices, flavored gelatin, popsicles, soft drinks, tea, and coffee. Provides hydration and calories in the form of simple carbohydrates.

  • Full Liquid Diet: Includes full liquids such as creamed soups, milk, ice cream, yogurt without fruits, pudding, milkshakes, etc.

Altered Texture Diets

  • Soft Diet: Low residue, digestible foods, few spices/condiments, fewer fruits/vegetables/meats.

  • Mechanical Soft Diet: For chewing difficulties, includes cooked fruits & vegetables, and ground meats.

  • Pureed Diet: Foods processed in a blender.

Patient Feeding Procedures

  • Prepare the patient for mealtime (handwashing, sitting upright, pre-medication if needed).

  • Ensure correct diet tray and appropriate temperature of food.

  • Encourage self-feeding with special utensils.

  • Monitor the patient's intake.

Enteral and Parenteral Nutrition

  • Types of Enteral Tubes:

    • NG tube: Terminates in stomach.

    • NJ tube: Terminates in small intestine.

    • Gastrostomy tube: Surgically inserted into the stomach.

    • Jejunostomy tube: Surgically inserted into the jejunum.

Feeding Indications

  • Decompress the stomach, provide nutrition or medications, specimen collection, or for patients with no appetite or during comatose states.

Tube Feeding Procedures

  • Ensure tube placement is confirmed (aspiration and pH checks).

  • Secure placement with tape, keeping it centered to avoid pressure ulcers.

Enteral Feeding Tubes

  • Includes Gastrostomy/PEG and Jejunostomy tubes. Verify placement and residual volume before feedings. Flushing with water for patency before and after medications/feedings is essential.

Types of Enteral Feeding Formulas:

  • High Protein

  • Diabetic, etc.

Enteral Feeding Methods

  • Intermittent Tube Feedings: Administered in equal portions, may involve gravity or feeding pump.

  • Continuous Infusion Feeding: Administered via infusion pump over an extended period; ensures better tolerance and absorption.

Parenteral Nutrition

  • Administered via a central venous catheter, bypassing the GI tract.

  • Total Parenteral Nutrition (TPN): Delivers a high concentration of carbohydrates, protein, vitamins, minerals, and electrolytes.

  • Partial Parenteral Nutrition (PPN): Less concentrated, given through a peripherally inserted central catheter for patients meeting some nutritional needs orally.

Health Issues Related to Nutrition

  • Conditions such as Anorexia Nervosa, Bulimia, Obesity, Pregnancy, Smoking, HIV & AIDS, pre- and post-operative considerations.

Functions of Water

  • Maintains body temperature, transports nutrients, cushions organs, lubricates joints, and removes toxins.

Fluid & Electrolyte Balance

  • Electrolytes: minerals or salts dissolved in bodily fluid essential for balance, acid-base maintenance, enzyme function, and neuromuscular activity.

Water Functions

  • Vehicle for transport, thermoregulation, acid-base balance, and medium for digestion.

Electrolytes Overview

  • Major Electrolytes:

    • Sodium: CNS, muscle function, blood pressure regulation, fluid balance.

    • Chloride: Aids HCL production in stomach, balances fluids.

    • Potassium: Muscle contractions and heart rhythm regulation.

    • Calcium: Bone strength, muscle contraction, and nerve function.

    • Magnesium: Muscle function and energy metabolism.

    • Phosphate: Bone health, energy transfer.

Sodium Normal Range: 135-145 mEq/L

  • Regulation of water and blood pressure; excess sodium (Hypernatremia) caused by dehydration, excessive input; deficiency (Hyponatremia) from loss or dilution.

Potassium Normal Range: 3.5-5.0 mEq/L

  • Essential for heart muscle and nerve function; excess (Hyperkalemia) can cause cardiac issues, while deficiency (Hypokalemia) impacts muscle and cardiovascular function.

Calcium Normal Range: 9-11 mg/dL

  • Essential for bones and muscle contraction; Hypercalcemia leads to weakness; Hypocalcemia causes muscle spasms and cardiac changes.

Magnesium Normal Range: 1.3-2.1 mEq/L

  • Involved in energy transfer; Hypermagnesemia can cause lethargy, while hypomagnesemia causes twitching and cardiac dysfunction.

Phosphate Normal Range: 1.7-2.6 mEq/L

  • Crucial for bone health; Hyperphosphatemia often results from renal failure, while hypophosphatemia can cause weak bones and muscle function issues.

Clinical Applications

  • Normal and abnormal findings in electrolyte levels should be monitored closely, especially during IV therapy.

  • Nurses should assess and document electrolyte imbalances carefully, as they can lead to severe complications.

Fluid Imbalances Overview

  • Fluid Volume Deficit (Dehydration): Symptoms include increased temperature, thirst, weakness, postural hypotension, decreased urine output.

  • Fluid Volume Excess (Overhydration): Symptoms include weight gain, bounding pulse, elevated blood pressure, and edema.

Urinary Elimination Functions

  • Role of the urinary system includes blood filtration, waste removal, excess water removal, electrolyte regulation, and acid-base balance.

  • Norms for urinary output include 1-3 liters per day, and acceptable hourly output should be 30 mL.

Alterations in Urinary Output

  • Oliguria: Less than 30 mL/hr.

  • Polyuria: More than 3,000 mL/day.

  • Anuria: Absence of urine.

  • Dysuria: Painful urination.

  • Incontinence: Involuntary urination.

Characteristics of Urine

  • Color: Straw-colored generally indicates hydration.

  • Clarities: Should be clear without sediments.

  • Odor: Should have a mild aromatic smell.

  • Specific gravity: 1.010-1.030 indicating hydration status.

Urinary Catheterization Overview

  • Types include standard and fracture bedpans, urinal devices for male patients, and urinary catheters (sterile insertion).

  • Teach proper care of catheters, signs of complications, and removal protocol.

Bowel Elimination Overview

  • Stool characteristics and abnormalities include color, odor, consistency, and presence of blood or mucus.

  • Fecal Incontinence: Lack of control over feces, which can have numerous causes.

  • Enemas and bowel procedures require understanding of types, uses, and potential complications.

Nursing Management Summary

  • Proper assessment, monitoring, and interventions for maintaining fluid and electrolyte balance are critical, especially for patients with altered nutrition.

  • Document all findings and ensure patient safety through appropriate interventions and education.