Comprehensive Nursing Notes on Nutritional Concepts and Complementary Therapies

Chapter 19: Nutritional Concepts and Related Therapies

Nutrition Definition: Nutrition is the sum of all processes involved in the ingestion and absorption of food substances. It is vital for proper growth and functioning, maintenance of health, resistance to disease, and the provision of energy. Nutrition plays a role, either directly or indirectly, in every body process.
Role of the Nurse in Promoting Nutrition:
- Patient Education: Help the patient understand the critical importance of their diet.
- Encouraging Compliance: Motivate patients to follow prescribed diets and make appropriate food choices.
- Physical Assistance: Assist patients with specific needs during mealtime.
- Documentation: Obtain and record patient weights accurately ( $lbs$ versus $kg$ ). Record patient intake, including the percentage of meal completion and fluid intake.
- Observation: Monitor for clinical signs of poor nutrition and document or report these findings accordingly.
Diet Planning and Health Promotion:
- Dietary Habits: Good habits promote health and reduce the risk of major chronic diseases.
- MyPlate (2011): A visual guide developed to help consumers make healthier food choices.
- Dietary Guidelines for Americans: Emphasizes a healthy eating pattern across the entire lifespan. It aims to maintain healthy body weight, support nutrient needs, and reduce chronic disease risk. Guidelines focus on variety and volume while limiting calories from sugar, fats, and sodium ( $Na$ ).
Food Labels and FDA Requirements:
- The FDA requires all ingredients to be listed in order of prevalence (the most abundant ingredient first).
- Labels must include: calories from fat, total fat (including saturated, unsaturated, and trans fats), cholesterol, proteins, vitamins A and C, carbohydrates, sodium ( $Na$ ), calcium, and iron ( $Fe$ ).
- Quick Guide for Percent Daily Value (% DV):
  - $5\%$ or less is considered low.
  - $20\%$ or more is considered high.

Essential Nutrients: Classes and Functions

Definition: Essential nutrients are necessary for life and cannot be manufactured by the body in sufficient amounts. They must be obtained through diet. They provide energy, build and repair tissue, and regulate body processes (metabolism).
The Six Classes of Essential Nutrients:
1. Carbohydrates (Energy Source): All carbohydrates break down into simple sugar.
  - Simple Carbohydrates: Monosaccharides (e.g., Fructose/fruit sugar and Glucose) enter the blood directly without digestion. Disaccharides (e.g., Sucrose/table sugar and Lactose/milk sugar) must be broken down.
  - Complex Carbohydrates (Polysaccharides): Starch (found in grains, legumes, and vegetables) and Glycogen.
  - Glycogen: Liver glycogen stabilizes blood sugar and feeds the brain; muscle glycogen provides energy directly to muscles.
  - Dietary Fiber:
    - Insoluble Fiber: (Whole wheat, grains, vegetables) Softens stools, increases peristalsis, and treats diverticulosis or hemorrhoids.
    - Soluble Fiber: (Oat bran, barley, nuts, seeds, apples) Binds with cholesterol and bile acids and provides satiety (fullness).
2. Fats and Lipids: Concentrated energy source providing $9\,kcal/g$ .
  - Types: Saturated (animal origin, solid at room temp), Monosaturated (plant origin: avocados, peanuts, canola oil), Polyunsaturated (plant and fish oils), and Trans-fatty acids (bad commercial fats like margarine).
  - Cholesterol is found in egg yolks and meat.
3. Proteins (Tissue Repair): Formed by amino acids and necessary for wound healing. Provides $4\,kcal/g$ .
  - Complete Proteins: Contain all 9 essential amino acids (animal meat, eggs, milk, soy, and quinoa).
  - Incomplete Proteins: Lack one or more amino acids (plants, grains, nuts, seeds).
  - Deficiency States: Marasmus (tissue wasting, "skin and bones") and Kwashiorkor (severe protein restriction results in edema of feet, ascites, and fatty liver).
4. Vitamins: Micronutrients for metabolism and growth.
  - Fat-soluble (stored in body): Vitamins A, D, E, and K.
  - Water-soluble (lost in urine): Vitamins B (Niacin, Folic Acid for neural tube defects, B12) and Vitamin C (ascorbic acid for wound healing and iron absorption).
  - Pernicious Anemia: Caused by a lack of intrinsic factor from the stomach, preventing B12 absorption.
5. Minerals: Inorganic elements that regulate body functions.
  - Major ( $> 100\,mg/day$ ): Calcium ( $Ca$ ), Sodium ( $Na$ ), Potassium ( $K$ ), Magnesium ( $Mg$ ), Phosphorus, Sulfur, Chloride ( $Cl$ ).
  - Trace ( $< 100\,mg/day$ ): Iron ( $Fe$ ) for hemoglobin, Zinc, Iodine (for thyroxin), Chromium, Selenium, Copper, Manganese, Fluoride.
6. Water: Essential for all life processes.

Clinical Laboratory Values and Nutritional Assessment

Albumin: A protein made by the liver that keeps plasma in the vessels. High levels indicate dehydration; low levels indicate malnutrition or liver/kidney disease.
Prealbumin: Levels are reduced by inflammation, stress, illness, or injury.
Blood Urea Nitrogen (BUN): Indicators of kidney dysfunction, liver damage, dehydration, high protein diets, or shock.
Urinary Creatinine: High levels indicate kidney disease.
Serum Transferrin: Measures the iron-carrying capacity of RBCs.
Hemoglobin: Iron-containing protein that carries oxygen.

Medical Nutrition Therapy (MNT) and Therapeutic Diets

Consistency Modifications:
- Clear or Full Liquids
- Thin or Thickened Liquids
- Soft and Mechanical Soft diets
- Low Residue (low fiber, restricts milk products)
Calculations for Energy Potential:
- Carbohydrates and Proteins: $4\,kcal/g$ (e.g., $3\,g\text{ bread} = 12\,kcal$ ).
- Fats: $9\,kcal/g$ (e.g., $3\,g\text{ butter} = 27\,kcal$ ).
- Alcohol: $7\,kcal/g$ .
Fluid Intake Monitoring:
- Includes anything liquid at room temperature.
- Ice chip conversion: Ice chips are counted as $50\%$ of their volume (e.g., $240\,ml\text{ of ice chips} = 120\,ml\text{ of } H_2O$ ).
Obesity: Managed through kilocalorie-controlled diets. Measurements include BMI, waist circumference, and body composition.
Diabetes Mellitus Management:
- Type 1: Pancreas fails to make insulin; usually diagnosed in children. (Only $5\%$ of cases).
- Type 2: Metabolic disorder where cells are resistant to insulin.
- Blood Sugar Ranges:
  - Normal fasting: $70-99\,mg/dL$
  - Prediabetes: $100-125\,mg/dL$
  - Type 2 Diabetes: $126\,mg/dL$ or higher
- Classic Symptoms (The 3 P's): Polyuria (frequent peeing), Polydipsia (extreme thirst), Polyphagia (extreme hunger).
Specific Diets for Diseases:
- DASH Diet: Dietary Approaches to Stop Hypertension (Sodium restriction).
- Dumping Syndrome: Triggered by high sugar; causes cramping and palpitations. Patients should avoid high sugar intake.
- Hepatobiliary/Pancreatic Support: Requires fat-controlled or no-fat diets due to malabsorption issues, which present as steatorrhea or flatulence.

Enteral and Parenteral Nutrition

Enteral Nutrition: Nutritionally-balanced liquefied food administered via feeding tube into the GI tract.
- Types: Nasogastric (NG), Gastrostomy (G-tube), Percutaneous Endoscopic Gastrostomy (PEG), or Jejunostomy.
Parenteral Nutrition: Total Parenteral Nutrition (TPN) administered through an IV, usually a central line.
Aspiration Precautions: Elevate the Head of Bed (HOB) and use thickened liquids for dysphagia.

Chapter 20: Complementary, Integrative, and Alternative Therapies

Definitions:
- Complementary Therapies: Used in addition to allopathic (conventional) medicine.
- Alternative Therapies: May replace conventional medicine; often become the primary modality.
- Integrative Care: The assimilation of complementary therapies with conventional care based on scientific safety and efficacy.
Holistic Nursing: Addresses the mind-body-spirit. Standards are maintained by the American Holistic Nurses Association. Examples include music therapy, guided imagery, and prayer.
Herbal Therapy:
- Herbs are sold as food supplements and are not regulated like pharmaceuticals; dosages are often inconsistent.
- Specific Herbs:
  - St. John’s Wort: Beneficial for mild/moderate depression.
  - Valerian: Used for insomnia; may be habit-forming.
  - Ginger: Helpful for morning sickness.
Physical and Manipulative Therapies:
- Chiropractic Therapy: Joint manipulation to restore alignment. Contraindicated in patients with osteoporosis.
- Acupuncture: Insertion of needles to modify pain perception and normalize physiology.
- Acupressure and Massage: Pressure applied to soft tissue. Contraindicated for patients with phlebitis, thrombosis, or infectious diseases.
- Yoga: Combines mind, body, and spirit. Caution: Patients with glaucoma should avoid inversions (e.g., downward dog).
Mind-Body and Sensory Interventions:
- Aromatherapy: Use of pure plant oils. Contraindicated in those with respiratory complications.
- Animal-Assisted Therapy: Reduces pain, BP, stress, and anxiety; often used for PTSD.
- Biofeedback: Noninvasive monitoring of pulse, BP, and respirations to determine autonomic responses.
- Tai Chi: Meditative exercise focusing on balance and leg strength.
Legal and Ethical Considerations:
- Medical Marijuana: PA Medical Marijuana Law exists, but marijuana is not recognized as therapeutic at the Federal level.
- Nursing Role: Nurses must practice within the scope of state laws, perform spiritual assessments (mandated by the Joint Commission), and remain nonjudgmental during health history collection.