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Comprehensive Nutrition & Nutritional Support Notes
Comprehensive Nutrition & Nutritional Support Notes
Nutrition Fundamentals
Nutrition = sum of processes by which an individual ingests and utilizes nutrients
Spectrum of nutritional status
Undernutrition: intake < metabolic needs ⇒ energy, protein, micronutrient deficits
Normal (euntrition): intake ≈ needs
Over-nutrition: intake > needs ⇒ overweight, obesity, hypervitaminosis, etc.
Balanced diet must supply
Macronutrients: carbohydrates, fats (lipids), proteins
Micronutrients: vitamins, minerals, electrolytes
Water (critical solvent & transport medium)
Estimating daily caloric need
Simple method: kilocalories per kilogram
Average adult requirement ≈ 20\text{–}35\;\text{kcal}\,/\,\text{kg}\,/\,\text{day}
Macronutrients: Carbohydrates
Primary (chief) source of body fuel ("protein-sparing" role)
Energy yield: 4\;\text{kcal/g}
Recommended daily share: 45\%\text{–}65\% of total calories
Fiber goal: 14\;\text{g} per 1000\;\text{kcal} consumed
Classification
Simple carbohydrates
Monosaccharides: glucose, fructose (also galactose)
Disaccharides: sucrose, maltose, lactose
Complex carbohydrates
Polysaccharides (starches) in cereal grains, potatoes, legumes
Macronutrients: Fats (Lipids)
Major concentrated energy source
Energy yield: 9\;\text{kcal/g} ( > 2× carbohydrate/ protein)
Storage: adipose tissue & visceral (abdominal) cavity
Functions
Vehicle for fat-soluble vitamins & essential fatty acids
Organ protection, thermoregulation, satiety, cell membrane integrity
Recommended intake: 20\%\text{–}35\% total calories
Quality spectrum
Potentially harmful: saturated fatty acids, trans-fatty acids
Healthier: monounsaturated & polyunsaturated fats
“Heart-healthy” focus: polyunsaturated omega-3 FAs (e.g., EPA, DHA)
Macronutrients: Proteins
Functions: tissue growth/repair/maintenance, enzymes, hormones, fluid balance, acid–base balance, immune function, energy
Energy yield: 4\;\text{kcal/g}
Daily caloric contribution: 10\%\text{–}35\%
Structural unit = amino acid
Body synthesises non-essential AAs
Nine essential AAs must come from diet
Protein quality
Complete (high-biologic value): eggs, fish, meats, milk/milk products, poultry ⇒ contain all essential AAs in adequate amounts
Incomplete: grains, legumes, nuts, seeds ⇒ limiting AA(s)
Micronutrients: Vitamins
Organic compounds needed in minute quantities for normal metabolism; act mainly as coenzymes
Categories
Water-soluble: vitamin C, B-complex (B₁, B₂, B₃, B₅, B₆, B₇, B₉, B₁₂)
Fat-soluble: vitamins A, D, E, K
Minerals
Inorganic elements; constitute ≈4\% of body weight
Roles: tissue building, fluid & electrolyte balance, nerve conduction, muscle contraction, cofactors in enzyme systems
Major (macro) minerals
Calcium, Chloride, Magnesium, Phosphorus, Potassium, Sodium, Sulfur
Trace (micro) elements
Chromium, Copper, Fluoride, Iodine, Iron, Manganese, Molybdenum, Selenium, Zinc
Special Diets & Cultural Competence
Vegetarian spectrum
Vegetarian (semi-, pesco-, pollo-): excludes red meat
Lacto-ovo: plants + dairy + eggs
Vegan: plants only; high risk for vitamin B₁₂ (cobalamin) deficiency ⇒ megaloblastic anaemia & neuropathy
Keys to vegetarian adequacy: complementary proteins, vitamin B₁₂, iron, calcium, vitamin D, omega-3 FAs
Iron-rich foods (selected)
Fortified cereals (farina, oatmeal, ready-to-eat cereal)
Animal sources: beef/chicken/turkey/pork liver, clams, oysters
Plant/alternate: soybeans
Culturally competent care
Ascertain traditional foods, religious laws (e.g., kosher, halal)
Teach modifications to whole family; avoid stereotyping
Malnutrition: Definitions & Types
Malnutrition = deficit, excess, or imbalance of essential nutrients
Undernutrition: inadequate intake, absorption, or utilization of nutrients
Overnutrition: excess nutrient/energy intake leading to obesity, hyperlipidemia, etc.
Etiologic categories (ASPEN)
Starvation-related (primary PCM): chronic starvation w/o inflammation (e.g., anorexia nervosa)
Chronic disease–related: mild–moderate inflammation (organ failure, cancer, RA, obesity)
Acute disease/injury–related: marked inflammation (major infection, burns, trauma, surgery)
Contributing factors
Socioeconomic: food insecurity, “heat-or-eat” dilemma, limited support programs
Physical illnesses: GI disorders, malabsorption, surgery, hospitalization
Psychosocial: fear, depression
Drug–nutrient & herb–drug interactions
Pathophysiology of Starvation
Stage 1 (0–18 h): use liver & muscle glycogen → glucose
Stage 2 (≥18 h): glycogen depleted ⇒ gluconeogenesis from skeletal protein → negative nitrogen balance
Stage 3 (≈day 5–9): lipolysis ↑, fat supplies up to 97\% of calories; protein conserved
Stage 4 (weeks 4–6): fat stores exhausted ⇒ visceral & somatic proteins catabolised
↓ liver protein synthesis, ↓ oncotic pressure ⇒ third spacing/edema (albumin leak)
Na⁺/K⁺ pump failure, fatty infiltration of liver
Without re-feeding ⇒ multi-organ failure & death
Clinical Manifestations of Malnutrition
Spectrum: mild weight loss → emaciation → death
Systems affected
Skin, hair, nails: dryness, brittle, thin, spoon nails
Oral cavity: glossitis, stomatitis
Musculoskeletal: wasting/weakness
CNS: confusion, irritability, paresthesias
Immune: infection susceptibility ↑
Hematologic: anemia (↓RBC, ↓Hgb), lymphopenia
Diagnostic & Assessment Tools
History: 7-day food recall, weight changes, comorbidities, meds
Anthropometrics: height, weight, BMI, mid-arm circumference, skinfold thickness
Screening instruments: Mini-Nutritional Assessment (MNA), Minimum Data Set (MDS), OASIS
Labs
Serum albumin (long-term), pre-albumin (short-term), C-reactive protein (inflammation)
Electrolytes, CBC, lymphocyte count
Functional: hand-grip dynamometry
Nursing Management of Malnutrition
Diagnoses: impaired nutrition, intake, fluid imbalance, tissue integrity risk
Goals
Achieve target weight & calorie intake
Avoid complications (refeeding, infection, skin breakdown)
Interventions
High-calorie, high-protein meals & snacks; multiple small feedings
Calorie counts, diet diaries, supplements, appetite stimulants
Consult dietitian; educate on MyPlate, food labels
Monitor I&O, daily weights, labs; plan for discharge
Gerontologic Considerations
Age-related changes: dentition loss, decreased taste/smell, dysphagia, slowed GI motility, ↓ vision/hearing, limited finances
Increased vulnerability to malnutrition & EN/PN complications: fluid–electrolyte shifts, glucose intolerance, aspiration risk
Enteral Nutrition (EN)
AKA tube feeding; delivery of nutritionally complete liquefied formula via GI tube
Tube routes: stomach (gastric), duodenum, jejunum
Indications: anorexia, orofacial fractures, head/neck cancer, neurologic disorders, burns, critical illness, chemo/radiation
Advantages vs PN: physiologic, safer, cheaper, maintains gut integrity
Formulas: standard (1–2 kcal/mL), disease-specific (DM, renal, hepatic, pulmonary)
Delivery modalities
Continuous pump, cyclic, bolus gravity, bolus syringe
Tube types
Nasogastric/nasointestinal (polyurethane/silicone): easy but may clog, dislodge, knot
Gastrostomy (PEG) or jejunostomy: long-term; require functional GI tract; placed surgically, radiologically, endoscopically
PEG: endoscopic placement; feed within 4\text{–}24\;\text{h} once bowel sounds present
Administration & Safety
ASPIRATION is major risk
Position: HOB 30^{\circ}\text{–}45^{\circ} during & 30\text{–}60\;\text{min} post-feed
Tube position verification
Gold standard: radiographic confirmation (X-ray)
Mark exit length; check pH, aspirate, observe each use/q8h continuous
Residual volume: follow policy; consider promotility agents
Tube patency: flush 30\;\text{mL} warm water pre/post feeds & meds; continuous feeds via pump with occlusion alarm
Site care: daily assessment, manage bumper tension, dressings until healed, soap & water, skin barrier
Misconnection prevention: tracing lines, unique hubs; wrong connection can cause death
Monitoring
Weights, bowel sounds, I&O, capillary glucose, formula/change dates, tubing q24h
Complications: vomiting, dehydration (calorie-dense formula), diarrhea, constipation, skin irritation, tube dislodgement
Parenteral Nutrition (PN)
Intravenous delivery of nutrients for non-functional or inaccessible GI tract
Goals: meet requirements, promote anabolism, tissue repair
Indications: severe diarrhea/vomiting, GI obstruction, fistula, short bowel, severe malabsorption, intractable anorexia, complex surgery/trauma
Composition
Base: dextrose + amino acids; customized electrolytes, vitamins, trace elements; IV fat emulsion (10%–30%) supplies up to 30\% calories
Dextrose: 100\text{–}150\;\text{g/day} ( 1\;\text{g}=3.4\;\text{kcal} )
Protein: 1\text{–}1.5\;\text{g/kg/day} (↑ in depletion)
Pharmacist compounds under strict aseptic conditions; refrigerated until <30\;\text{min} before use; labelled with content & expiration
Routes
Central PN: catheter tip in SVC (subclavian, jugular, or PICC); hypertonic (glucose 20\%\text{–}50\%); long-term
Peripheral PN: peripheral line; less hypertonic (≤20\% glucose); short-term, lower calorie/protein needs, lower central-line risk
Complications
Refeeding syndrome: fluid retention, electrolyte shifts; hallmark = hypophosphatemia
Metabolic: renal dysfunction, essential FA deficiency, hyper/hypoglycemia, hyperlipidemia, liver dysfunction
Catheter-related: air embolus, sepsis, dislodgement, thrombosis, phlebitis, hemorrhage, occlusion, pneumothorax, hemothorax, hydrothorax
Nursing Management
Vital signs q4–8h; daily weight
Capillary glucose q4–6h initially
Strict infusion pump; chart volume infused vs ordered
Labs: electrolytes, BUN, CBC, liver enzymes
Dressing changes with sterile technique; assess site for local & systemic infection (redness, tenderness, exudate; fever, chills, N/V, malaise)
Tubing & bag changed q24h; inspect solution for contamination
X-ray for catheter placement & pulmonary changes
Education for home PN: aseptic technique, bag mixing, line care, complication recognition, supplies procurement, discharge planning
Key Numerical & Formula Summary
Daily calories: 20\text{–}35\;\text{kcal/kg/day}
Carbohydrate energy: 4\;\text{kcal/g}
Fat energy: 9\;\text{kcal/g} (recommended 20\%\text{–}35\% calories)
Protein energy: 4\;\text{kcal/g} (target 10\%\text{–}35\% calories; 1\text{–}1.5\;\text{g/kg/day} in PN)
Fiber: 14\;\text{g}/1000\;\text{kcal}
Enteral formulas: 1\text{–}2\;\text{kcal/mL}
Lipid emulsion PN: 10\% = 1\;\text{kcal/mL}; max 2.5\;\text{g/kg/day}
Tube flush standard: 30\;\text{mL} warm water
HOB elevation: 30^{\circ}\text{–}45^{\circ}
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Explore Top Notes
Chapter 2: Beginnings of English America (1607-1660)
Note
Studied by 58 people
5.0
(1)
y9 health
Note
Studied by 6 people
4.0
(2)
Ultimate AP Pre Calc Notes (original)
Note
Studied by 1444 people
5.0
(1)
APUSH midyear
Note
Studied by 23 people
4.0
(1)
Chapter 26: Prosperity and Anxiety: The 1950s
Note
Studied by 18 people
5.0
(1)
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Note
Studied by 31 people
5.0
(3)