NSG 1050 - Module 5 flashcards

Basal metabolic rate (BMR) - Minimal energy at rest needed to maintain digestion, circulation, etc. (Essentially homeostasis)

Resting energy expenditure (REE) - The amount of energy you need to consume over a 24 hour period to sustain life while at rest. (The thing that provides energy for the basal metabolic rate)

Kilocalories (KCAL) - The basic energy unit that we use to measure how much energy something has. “One kilocalorie is the amount of heat required to raise the temperature by one degree for one kilogram or one liter of water by one degree celsius”

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• Carbohydrates (CHO): 1 gram of CHO = 4 kcal

> Two types of carbohydrates: Simple carbs = Glucose. Complex/polysaccharides = starches

> Fiber is also a type of polysaccharide, found in plants as cellulose. Does not produce any calories as it is not broken down in the body.

• Protein: 1 gram of protein = 4 kcal

> Amino acids are building blocks of proteins. 

> There are 9 indispensable amino acids. The body makes 11 dispensable amino acids 

> Protein will be broken down if no energy is consumed.

> Tissue needs protein to be repaired.

> Carbs and fats are used for energy before proteins. So eat more than just proteins.

Fat: 1 gram of fat = 9 kcal

> Fat (or triglycerides) is the most energy dense nutrient
> Saturated vs. Unsaturated fats: Saturated fats are not effective for energy usage. They are responsible for plaque buildup in our cardiac muscles or circulatory system. But they can be protective if used properly. Fats such as fish oils are healthy because they are unsaturated fats.

Water 

> Makes up 60% of body weight and is critical for proper body function. Daily fluid intake is crucial.

Vitamins

- Fat soluble (D, A, K, E)

- Water soluble (C and B complex)

> Neutralization of free radicals reduces the risks for certain cancers.

>Antioxidant vitamins include vitamins A, C, and E. 

Minerals

Inorganic elements that are catalysts to aid in body functions.

1,500-1,800 calories are recommended for adult weight loss for both men and women for approximately 1-2 pounds per week.

WORK ON RATIOS FOR THE WEIGHT LOSS PROBLEMS

Example:

A patient wants to consume 1,500 calories and have 40% be protein, 30% carbohydrates, 30% fat

Protein: 600 calories = 150 grams of protein per day

Carbs: 450 calories = 112.5 grams of carbs per day

Fat: 450 calories = 50 grams of fat per day

A&P of the digestive system

Digestion\/

   Absorption\/

      Metabolism and storage of nutrients\/

         Elimination

READ IN TEXTBOOK!!!!

IMPORTANT!!! 

TIMESTAMP TO LOOK AT DIAGRAM 18:05

1. Mouth: Chews food and mixes it with saliva

2. Salivary glands: Produce saliva which contains a scratch-digesting enzyme called salivary amylase

3. Pharynx: Swallows the chewed food mixed with saliva called bolus

4. Esophagus: Moves the bolus to the stomach

5. Stomach: Mixes and churns food with gastric juice that contain acid and a protein-digesting enzyme called pepsin creating chyme

6. Liver: Makes bile which aids in the digestion and absorption of fat.

7. Pancreas: Releases bicarbonate to neutralize intestinal contents; produces enzymes that digest carbohydrates, protein, and fat

8. Gallbladder: Stores bile and releases it into the small intestine when needed

9. Small intestine: Digests food and absorbs nutrients into blood or lymph

10. Large intestine: Absorbs water and some vitamins and minerals; home to intestinal bacteria; passes waste material

11. Anus: Opens to allow waste to leave the body

Dietary guidelines

• Dietary reference intakes (or DRI’s) 

Amount of vitamins and nutrients for each sex and for different ages

4 parts of the DRI:

1 = Estimated Average Requirement (EAR) amount of a nutrient to maintain a specific body function for 50% of the population based on age and gender. he

2 = Recommended Dietary Allowance (RDA) average needs for 98% of the population.

3 = Adequate Intake (AI) based on individuals from experimentally determined estimates.

4 = Upper intake Level (UL) the highest amount of something that will likely not cause adverse effects.

• Daily values are on food labels.

• Food guidelines

https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials

• Daily values = Based on the requirements of an adults eating 2,000 calories a day.

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Nursing Knowledge base

Factors influencing nutrition — Cultural, geographic, sociological, economic. Understanding a person’s beliefs and background allow for a better understanding of how they view nutrition to better advocate and communicate their specific plan to them.

Development needs across the lifespan

LOOK IN BOOK!!!!!!!!!!!!!!!!!!!

• Infants through school age — 

Very high nutritional need in infants because of rapid growth. Breastfeeding is recommended for 6 months and incorporating other foods after 12 months. Avoid cows milk the entire first year of life! Difficulties with infants kidneys.

After one year of age, convert to whole milk until the age of two. The fats are crucial for proper neurological development. With the fats wrapping around the axon in the form of myelin sheaths and therefore the development of the brain.

School-age children you need to assess for deficiencies, protein intake, vitamin A, C. Know the snacks and the quality of snacks. Because especially at this age there is a risk for childhood obesity for a few reasons: 1. School-age kids are more independent and there is less supervision of snacking. Adolescents due to their rapid development have increased energy needs. They need a large amount of calcium due to rapid bone growth and formation. They need B complex vitamins, because of high metabolic activity. Adolescents due to development and puberty and body image are at significant risk for nutritional deficiencies and eating disorders. Many adolescents participate in sports and might not have their nutritional needs being met effectively.  2. 

• Young and Middle adults — Growth needs are not needed, but diet rarely changes. Table 45.3 Cultural dietary practices. How does their faith affect how they eat? Their culture is how they say it is. Listen to your patients!!! Vegetarian isn’t bad, just ensure that protein needs are being met.

LOOK IN TEXTBOOK!!! 

• Older adults — 

Alternative food patterns

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Nursing process: Assessment DPIE

—Assessment

• You need to listen to your patient before you can try to enact any changes. How else do you have buy-in if you do not listen to them? Try to have a positive intervention

• Through the patient’s eyes

• Screening

• Anthropometry

• Laboratory and Biochemical tests

• Diet history and health history

• Environment

—Physical Examination

ATI Nutrition Notes

The balance between caloric intake and energy expenditure is important for your role as an educator.

Physiology of digestion

Digestion is breaking down food into simpler substances to get chemical energy out.

Smooth muscle contractions that propel food through the body are known as peristalsis.

Esophagus is hollow and leads to the stomach, which holds and digests food using acids and enzymes. Food stays in the stomach for 2-8 hrs.

Liver removes toxins from the blood and produces bile, which breaks down carbs, proteins, and fats.

Gallbladder stores bile and then releases it when the body needs it.

Pancreas aids in the metabolism of sugar by producing insulin. 

Small intestine is where food is broken down and the majority of the nutrients are absorbed.

Large intestine removes electrolytes and water from food while turning it into waste.

Rectum storage area for feces at the end of the large intestine.

Anus is the external opening of the rectum where feces is removed from the body.

Nurses should frequently check up on their clients to make sure they do not have any digestive issues.

The esophagus is a tube that extends from the mouth to the stomach; muscles in this structure propel food from the mouth to stomach. The stomach holds and digests food, with food remaining in the stomach for 2 to 8 hours. The liver produces bile, which the gallbladder stores and releases. The pancreas produces insulin, a hormone that helps metabolize sugars. The small intestine is responsible for absorbing most of the nutrients from food, while the large intestine helps turn the rest to feces. The feces are then temporarily stored in the rectum until removed from the body as waste via the anus (Patricia & Dhamoon, 2020; Ruiz, 2019).

Healthy eating patterns

Calories - The energy that is stored in food and used for processes of the body such as walking, breathing, and running.

Daily adult intakes for food should include: 2 cups of fruit, 2 ½ cups of vegetables, 6 ounces of grains, 5 ½ ounces of protein, and 3 cups of dairy products.

A healthy weight-loss plan consists of losing 1-2 pounds per week.

Losing 5-10% total body weight can improve bp, bg, cholesterol levels.

Nutrient requirements

Nutrients are vital to help disease prevention, promote growth and health and provide nourishment. 

Caloric Requirements

Nutrients fall into two categories: Macronutrients and micronutrients,

Macros include: protein, carbohydrates, and fat. Which are required in large amounts. The building blocks of a diet.

Micros include: vitamins and minerals. Only a small amount of these are required. Required for optimal growth, development, and body function.

Protein - considered the major building block of the body, as it provides amino acids required for structure. It is also used to build and repair muscle.

Carbohydrates - macro that provides the body’s cells, organs, and tissues with the energy they need to function.

Around 45-65% of daily calories

A carbohydrate-containing food’s ability to increase the body’s blood glucose level.

Trans fats raise the low density lipoprotein (LDL) cholesterol level “bad cholesterol” and lower the high density lipoprotein (HDL) cholesterol level “good cholesterol”

Healthy fats are monounsaturated fats, found in nuts, olives, olive oil, seeds, and avocados.

Fats - essential nutrient that help the body absorb vitamins while providing energy.

Vitamins - Carbon-based organic micronutrients that promote health and support optimal functioning of the body.

Water-soluble vitamins - vitamins that are carried to the tissues of the body but are not stored in the body.

Water-Soluble Vitamins, Their Function, and Food Sources

I

Fat-soluble vitamins - vitamins that do not dissolve in water but instead are dissolved in fats.

Fat-Soluble Vitamins, Their Function, and Food Sources

M

Minerals - noncarbon, inorganic nutrients that promote health and support optimal functioning of the body.

Macrominerals - minerals needed in larger amounts

Trace minerals - needed in small amounts to help with different body functions.

Macrominerals: Their Function and Food Sources

Trace Minerals: Their Function and Food Sources

W

Water is an essential nutrient that makes up more than half of body weight. The National Academy of Sciences recommends that water intake from beverages should be about 2.7 to 3 liters for females and 3.5 to 3.7 for males

Nutritional Value of food

Food’s nutritional value is determined by the impact it has on the body. A food that has very little nutritional value is known as having empty calories

Calorie density.

Fruits and vegetables have a low calorie density.

Fast foods have a high calorie density.

Serving size indicated

Net carbs - The amount of carbs counted toward consumption after taking away the amount of fiber and sugar alcohols in a food.

The required information from the label needed to calculate the net carbs is the total carbohydrates per serving, dietary fiber, and alcohol sugars. Fiber and sugar alcohols essentially cancel out carbohydrates, which is where the term net carbs are derived. Not all food labels will have net carbs listed. In order to calculate net carbs, take the total carbs per serving and subtract the fiber and alcohol sugars. For example, if someone consumes food that has 10 g of carbohydrates and 5 g of fiber, the net carbs consumed would be 5 g. This is the amount used to calculate total daily carbohydrate intake.

A healthy weight indicates that a person has the correct amount of body fat in relation to their overall body mass. A healthy weight promotes an energetic feeling, prevents premature aging, and deceases health risks. A body mass index (BMI) calculator can help determine if a person is at a healthy weight or needs to lose or gain weight.

BMI categories include underweight, normal weight, overweight, and obesity. A BMI of less than 18.5 is considered underweight, while a BMI of 18.5 to 24.9 is considered normal (or healthy). A BMI of 25 to 29.9 is overweight, and a BMI of 30 or greater is categorized as obese.

A diet rich in foods containing antioxidants helps protect the cells from free radicals, which promote the development of cancer, heart disease, and other diseases. The best sources of antioxidants are plant-based foods, including vegetables, whole grains, fruits, nuts, and seeds.

Antioxidants - Substances, commonly found in plant-based foods, that protect the cells against free radicals.

It is normal for the skin to show changes related to aging, but skin health is also directly related to nutrition. A healthy diet can delay signs of skin aging. Consuming a diet rich in vitamins A, C, D, and E will promote skin health, and eating five or more servings of fruits and vegetables per day can help improve the skin’s appearance.

To support brain health, clients should consume a diet with adequate omega-3 fatty acids.

Omega-3 fatty acids - Found in a number of foods, mainly fish. Fish oil supplements are the most common nonvitamin/nonmineral natural product taken by adults and children.

FIBER CONTENT NEEDED DAILY FOR MEN AND WOMEN

Females should eat 25 g of fiber per day, while men should get 38 g of fiber daily. Fiber is also available as a supplement, but clients should discuss its use with the provider before starting such supplementation.

Nursing interventions

A nutritional assessment includes a collection and review of the client’s dietary habits to determine if all of the necessary nutrients are being consumed and if there are any health issues related to the client’s nutritional intake.

24-hour recall

Assessment tool used to help a client recall what they have eaten over the last 24 hours.

food frequency questionnaire

Tool used to determine a client's typical food consumption based on a list of foods.

NPO

Abbreviation meaning nothing by mouth.

Aspiration

When solids or liquids enter the lungs during inhalation.

Dysphagia

Difficulty swallowing.

regular diet

A healthy, varied diet with foods from all food groups.

soft diet

Diet containing foods that are soft, easy to digest, low in fiber, and easy to swallow without difficulty.

pureed diet

Diet of foods that do not require chewing.

full liquid diet

Diet of liquids, foods that are considered liquids, and foods that turn into liquids at room temperature.

clear liquid diet

Diet consisting of only liquids that are clear and offers little daily calories and nutrients.

The kidneys play an important role in the body by removing extra fluid and wastes.

renal diet

Diet for individuals with kidney disease that limits intake of sodium, potassium, and phosphorus.

Clients who have kidney disease should also limit their intake of potassium, as high potassium levels can lead to heart dysrhythmias and increase the risk of myocardial infarction.

To prevent excess levels of phosphorus from building up in the blood, the nurse should instruct clients on which foods should be avoided or limited. These include the following foods:

Dairy: Limit to 1 cup of milk per day or 1 ounce of another dairy product such as yogurt or cheese.

Dried beans: Limit to 1 cup per week.

Mushrooms: Limit to 1 cup per week.

Broccoli: Limit to 1 cup per week.

Brussels sprouts: Limit to 1 cup per week.

Eat white bread versus whole-grain bread.

Bran, wheat cereals, granola, and oatmeal: Limit to 1 serving per week.

Beer: Avoid.

Soft drinks: Drink clear drinks, but avoid colas, root beers, and similar beverages.

Nutritional Supplements

warfarin

Medicine that thins the blood to prevent blood clots.

An anticoagulant

When prioritizing client education using the safety/risk reduction framework, the nurse should first address the client's current use of warfarin, followed by the client's potential for supplement interactions. Warfarin's effectiveness can be reduced by vitamin K, increasing the risk of blood clots. Additionally, St. John's wort can decrease the effectiveness of several medications, including cardiac medications. It is crucial to prevent adverse outcomes by ensuring the client understands the risks associated with supplement interactions before starting any new regimen.

overt aspiration 

Aspiration causing symptoms such as coughing or trouble breathing.

silent aspiration

Aspiration with no obvious symptoms.

thickened liquids

Liquids that are thickened using powder or gel to help prevent aspiration for those with dysphagia.

The client should remain upright at 90° while eating either in the bed or chair, if able. A client who is at risk for aspiration should have their food cut into small bites for chewing, not cut in half. The client should be provided with extra time for chewing and swallowing each bite of food. Distractions such as watching television should be avoided, and the client should remain upright at 45° or more for at least 1 hour after eating

Assisting with Eating and Feeding

Before getting clients positioned to eat consider the following questions:

Do they need to use the restroom?

Have they washed their hands?

Are their dentures in place?

Are their hearing aids in place and turned on?

Are the surroundings free of clutter?

assistive devices

Equipment or tools that help a client perform daily tasks easier.

Swallowing Techniques

Glucose is the primary sugar found in the blood. It comes from food ingested by the individual and is the body’s major source of energy.

blood glucose

Provides energy to the cells in the body, primary sugar in the body that is made from foods eaten.

fasting blood glucose

Blood sugar level taken after a person has not eaten or drank anything for a least 8 hours.

A fasting blood glucose is a blood glucose level that is taken after a client has been NPO for at least 8 hours.

hypoglycemia

A blood glucose level below the expected reference range.

Young children usually need less than 15 grams of carbohydrates to fix a low blood glucose level; with infants needing 6 g, toddlers 8 g, and small children 10 g.

The expected reference for a fasting blood glucose level for a client who does not have diabetes is 70 to 110 mg/dL. A blood glucose level of less than 140 mg/dL after eating 2 hours prior is considered within the expected reference range.

Insulin is primarily administered via injection into the fatty tissue under the skin so that it reaches the blood. Insulin is dosed by units (U), with the most common strength being U-100 or 100 units of insulin per milliliter of fluid. Types of insulin are distinguished based on how fast the medication works in the body, how long it takes to achieve its peak action, and how long the effects last:

• Rapid-acting insulin starts to work in 15 to 30 minutes, peaks in 30 minutes to 3 hours, and has effects that last 3 to 5 hours.

• Regular or short-acting insulin starts to work in 30 minutes to 1 hour, peaks in 2 to 4 hours, and has effects that last 4 to 12 hours.

• Intermediate-acting insulin starts to work in 1 to 2 hours, peaks in 4 to 12 hours, and has effects that last 14 to 24 hours.

• Long-acting insulin reaches the bloodstream 2 to 4 hours after injection and has effects that last up to 24 hours.

• Ultra long acting insulin starts to work in 1 hour, peaks in 12 hours, and has an effect that lasts 24 to 42 hours.

A gastrostomy tube (G-tube) is a tube that delivers nutrition directly into the stomach. It is inserted through the abdomen and is indicated for clients who are unable to consume enough nutrition on their own.

The client is required to remain NPO for at least 8 hours prior to the procedure.

gastrostomy tube (G-tube)

Delivers nutrition to a client via a tube in the stomach.

Three methods are used to insert G-tubes: percutaneous endoscopic gastrostomy (PEG), laparoscopic technique, and open surgery technique. The most common technique used for G-tube placement is the PEG procedure. A G-tube can provide all of a client’s dietary intake, or it can be used to supplement any nutritional deficiencies the client may be experiencing.

laparoscopic technique

Procedure where small incisions are made on the abdomen and a tiny telescope is used to place a g-tube.

open surgery technique

Technique used to place a G-tube when laparoscopic is not an option; open surgery allowing the surgeon to complete other procedures if indicated.

A nasogastric (NG) tube is a thin plastic tube that is inserted into the nostril and down the esophagus, with the end placed in the stomach. It is primarily used to provide nutrition and medication to a client, but can also be used to remove contents from the stomach in the event of a client ingesting a harmful substance, poison, or too much medication.

nasogastric (NG) tube

Thin plastic tube placed via the nostril, down the esophagus and into the stomach.

A nasojejunal (NJ) tube is a thin, soft tube that is inserted through the nostril and stomach, ending in the jejunum of the small intestine. NJ tubes are used for clients who are unable to consume enough nutrition, cannot tolerate foods and liquids in their stomach, or have delayed gastric emptying.

nasojejunal (NJ) tube

Thin, soft tube placed in a nostril with the tip located in the jejunum.

enteral nutrition

Nutritional intake through the GI tract, including the mouth or a GI tube.

Parenteral nutrition is dietary intake that is administered intravenously (IV). Parenteral nutrition can prevent malnutrition by replacing missing nutrients that would be otherwise consumed with eating.

parenteral nutrition

Nutritional intake through the veins, given when a client's GI system does not function.

partial parenteral nutrition

Supplies a client with part of their nutritional requirements allowing for supplemental oral intake.

total parenteral nutrition

Intravenous liquid nutrition that makes up all of a client's nutritional intake.