Lecture 4 Part 1- Nutrition

‭Six Classes of Nutrients (Essential)‬ ‭●‬ ‭Must be consumed through food; not made in the body‬ ‭●‬ ‭Macronutrients: Nutrients that supply energy; needed in large quantities‬ ‭○‬ ‭Carbohydrates‬ ‭○‬ ‭Proteins‬ ‭○‬ ‭Lipids‬ ‭●‬ ‭Micronutrients: Nutrients that regulate body processes‬ ‭○‬ ‭Vitamins‬ ‭○‬ ‭Minerals‬ ‭○‬ ‭Water‬ ‭●‬ ‭Energy: 1 kilocalorie (kcal) = 1000 calories (cal) = 1 Cal‬ ‭○‬ ‭No longer used‬ ‭Carbohydrates‬ ‭●‬ ‭Organic compounds are composed of carbon, hydrogen, and oxygen: C‬‭n‬‭(H‬‭2‬‭O)‬‭n‬ ‭●‬ ‭Classified as simple or complex sugars‬ ‭●‬ ‭Glucose + galactose = lactose‬ ‭●‬ ‭Fructose is found in fruits‬ ‭●‬ ‭Building block is mainly glucose‬ ‭Carbohydrates‬ ‭Sugars (simple)‬ ‭Monosaccharide (glucose,‬ ‭galactose, fructose)‬ ‭Disaccharides (maltose,‬ ‭lactose, sucrose)‬ ‭Polysaccharides (complex)‬ ‭Starch, fibers, glycogen‬ ‭‬ S ● ‭ erve as the structural framework of plants; lactose is only animal source‬ ‭●‬ ‭Most abundant and least expensive source of calories in the world‬ ‭●‬ ‭More easily and quickly digested than protein and fat‬ ‭○‬ ‭Digestion begins in the oral cavity by amylase‬ ‭●‬ ‭Provide 4 Cal/g and 45-65% of total calories‬ ‭Examples of Simple Carbohydrates‬ ‭●‬ ‭Increases blood glucose very quickly, which can result in an insulin spike‬ ‭○‬ ‭Susceptible to central obesity and type II diabetes‬ ‭●‬ ‭Candy‬ ‭●‬ ‭Carbonated drinks‬ ‭●‬ ‭Chocolate‬ ‭●‬ ‭Cookies‬ ‭●‬ ‭Corn syrup‬ ‭●‬ ‭Brown sugar‬ ‭●‬ ‭Lactose in milk‬ ‭Examples of Complex Carbohydrates‬ ‭●‬ ‭Green vegetables‬ ‭●‬ ‭Whole grains, breads, pastas‬ ‭●‬ ‭Starchy vegetables (potatoes, corn, pumpkins)‬ ‭●‬ ‭Beans, peas, lentils‬ ‭●‬ ‭Why complex carbohydrates are good for you:‬ ‭○‬ ‭Takes more time to break down; provides energy for an extended period of time‬ ‭○‬ ‭Helps with losing weight; one feels full quickly and does not eat a lot‬ ‭○‬ ‭Promotes GI mobility‬ ‭○‬ ‭Keeps the heart healthy with minerals‬ ‭Protein‬ ‭●‬ ‭Composed of carbon, hydrogen, oxygen, and‬‭nitrogen‬‭(CHON)‬ ‭●‬ ‭22 amino acids (building blocks)‬ ‭●‬ ‭9 essential vs. 13 non-essential amino acids‬ ‭●‬ ‭Complete vs. incomplete protein‬ ‭Complete‬ ‭Incomplete‬ ‭Contains all 9 essential amino acids‬ ‭At least one essential amino acid is‬ ‭missing‬ ‭High quality‬ ‭Low quality‬ ‭Animal proteins‬ ‭Plant proteins‬ ‭Ex. eggs, dairy products, meats‬ ‭Ex. grains, legumes (beans, peas, lentils),‬ ‭vegetables‬ ‭‬ E ● ‭ xception:‬‭Soybeans‬‭are a plant-based (legume) complete‬‭protein (tofu)‬ ‭●‬ ‭Required for the formation of all body structures (skin, hair, organs, RBCs, enzymes)‬ ‭‬ P ● ‭ rovides 4 cal/g and 10-20% of total caloric intake‬ ‭●‬ ‭RDA (recommended daily allowance) for adults is 0.8g/kg‬ ‭●‬ ‭About 56-63 g of proteins are needed daily‬ ‭Nitrogen Balance‬ ‭●‬ ‭Protein tissues are in a constant state of flux (replacement)‬ ‭○‬ ‭Nitrogen balance = nitrogen anabolism (building) - catabolism (breakdown)‬ ‭●‬ ‭Nitrogen intake: Meat, dairy, eggs, legumes, grains, and cereals‬ ‭●‬ ‭Nitrogen loss: Urine, feces, sweat, skin, and hair‬ ‭●‬ ‭Negative nitrogen balance: Catabolism > anabolism‬ ‭○‬ ‭Burns, serious tissue injuries, fevers, hyperthyroidism, fasting, stress, wasting dz‬ ‭○‬ ‭Cause breakdown (muscle, metabolism, tissue)‬ ‭ uestion:‬‭While performing a nutritional assessment‬‭of a low-income family, the community‬ Q ‭health nurse determines that the family’s diet is inadequate in protein content. The nurse suggests‬ ‭which of the following foods to increase protein content with little increase in food expenditure?‬ ‭a.‬ ‭Oranges and potatoes‬ ‭b.‬ ‭Potatoes and rice‬ ‭c.‬ ‭Rice and macaroni‬ ‭d.‬ ‭Peas and beans‬‭(inexpensive)‬ ‭Lipids (Fats)‬ ‭●‬ ‭Digestion occurs largely in the small intestines by lipase‬ ‭●‬ ‭Most concentrated source of energy in the diet‬ ‭●‬ ‭Provides 9 cal/g‬ ‭●‬ ‭Should provide ≤ 20-35% of caloric intake‬ ‭●‬ ‭Major types include triglycerides, cholesterols, phospholipids‬ ‭Triglycerides‬ ‭●‬ ‭Major form of fat in the body: 95% of lipids in diet‬ ‭●‬ ‭Made of 3 fatty acids (building block) + glycerol (C‬‭3‬‭H‬‭8‭O ‬ ‬‭3‬‭)‬ ‭●‬ ‭Saturated fatty acid: CH‬‭3‬‭(CH‬‭2‭)‬ nCOOH‬ ‭○‬ ‭No double bonds; saturated by hydrogen‬ ‭●‬ ‭Unsaturated fatty acid: CH(CH‬‭2‬‭)mCOOH‬ ‭○‬ ‭More than one double bond; not completely saturated by hydrogen‬ ‭●‬ ‭Most animal fats are considered saturated; solid at room temperature‬ ‭○‬ ‭Better for food companies since they have a longer shelf-life‬ ‭●‬ ‭Most vegetable fats are considered unsaturated; liquid at room temperature (reactive)‬ ‭○‬ ‭Hydrogenated liquid oils → trans fat (eg. margarine, shortening, microwave‬ ‭popcorn)‬ ‭○‬ ‭Adding hydrogen to make unsaturated fat to make it saturated‬ ‭Cholesterol‬ ‭●‬ ‭Insoluble in water and blood, but hormones must travel through the bloodstream‬ ‭●‬ ‭Travel via protein attachment → lipoprotein‬ ‭●‬ ‭Lipid profile‬‭: Used to determine cholesterol levels‬‭in the blood‬ ‭○‬ ‭Triglycerides: < 150 mg/dL‬ ‭○‬ ‭Low-density lipoprotein (LDL): < 130 mg/dL‬ ‭■‬ ‭“Bad,” Can cause atherosclerosis and CDV dz‬ ‭○‬ ‭High-density lipoprotein (HDL): > 50 mg/dL‬ ‭■‬ ‭“Good”‬ ‭○‬ ‭Total cholesterol (HDL + LDL + 20% of triglycerides): < 200 mg/dL‬ ‭●‬ ‭Saturated fatty acids → raise LDL levels‬ ‭●‬ ‭Unsaturated fatty acids → lower LDL levels‬ ‭ uestion:‬‭A nurse is caring for a client with a history‬‭of cardiac and vascular disease. Which of‬ Q ‭the following fats should the nurse allow in the client’s diet for his condition?‬ ‭a.‬ ‭Unsaturated fat‬ ‭b.‬ ‭Trans fat‬ ‭c.‬ ‭Saturated fat‬ ‭d.‬ ‭Hydrogenated fat‬ ‭ uestion:‬‭A food contains 5 g of carbohydrates, 10‬‭g of fat, and 5 g of protein. How many‬ Q ‭calories does this food provide?‬ ‭a.‬ ‭20‬ ‭b.‬ ‭80‬ ‭c.‬ ‭105‬ ‭d.‬ ‭130‬ ‭Vitamins‬ ‭●‬ ‭Organic compounds needed in small amounts‬ ‭●‬ ‭A co-enzyme that initiates chemical reactions in the body‬ ‭●‬ ‭Essential for metabolism of carbohydrates, protein, and lipids‬ ‭●‬ ‭Vitamin deficiency mostly affects older adults, children, alcohol abusers, and picky eaters‬ ‭●‬ ‭Classified as water-soluble or fat-soluble‬ ‭○‬ ‭Water-soluble: B and C complex (not stored in the body)‬ ‭○‬ ‭Lipid-soluble: A, D, E, K (stores in the liver and adipose tissue)‬ ‭●‬ ‭Vitamin A: Visual acuity, skin and mucous membranes, immune function‬ ‭●‬ ‭Vitamin D: Calcium and phosphorous metabolism (bone and muscular integrity),‬ ‭stimulates calcium absorption‬ ‭‬ V ● ‭ itamin E: Antioxidant protecting cells from oxidation‬ ‭●‬ ‭Vitamin K: Synthesis of certain proteins necessary for blood clotting, RBC production‬ ‭Question:‬‭All of the following are a good source of‬‭vitamin D except…‬ ‭a.‬ ‭Blueberries‬‭(more vitamin C and antioxidants)‬ ‭b.‬ ‭Sunlight (produces vitamin D endogenously)‬ ‭c.‬ ‭Salmon, tuna, sardines, and mackerel‬ ‭d.‬ ‭Fortified milk (added calcium and vitamin D) and other dairy products‬ ‭Minerals‬ ‭●‬ ‭Inorganic elements found in all body fluids and tissues‬ ‭●‬ ‭Some function to provide structure in the body, others help regulate body processes‬ ‭●‬ ‭Major minerals (> 5 g):‬ ‭○‬ ‭Sodium (Na): Major in extracellular‬ ‭○‬ ‭Potassium (K): Major in intracellular‬ ‭○‬ ‭Calcium (Ca): Bone formation, blood clotting, nerve function, muscle contraction‬ ‭○‬ ‭Phosphorus (P): Bone formation, carbohydrate and fat metabolism‬ ‭○‬ ‭Magnesium (Mg): Bone formation, protein synthesis, carbohydrate metabolism‬ ‭○‬ ‭Sulfur (S): Promotes certain enzyme reactions‬ ‭○‬ ‭Chloride (Cl): Component of HCl in the stomach‬ ‭●‬ ‭Trace minerals (<)‬ ‭○‬ ‭Iron (Fe), zinc (Zn), chromium (Cr), manganese (Mn), copper (Cu), fluoride (F‬‭-‬‭),‬ ‭iodine (I), molybdenum (Mb)‬ ‭Water‬ ‭●‬ ‭Accounts for between 50-60% of adult’s total weight‬ ‭●‬ ‭Two-thirds of body water is contained within the cells (ICF)‬ ‭●‬ ‭Remainder of body water is (ECF), body fluids (plasma, interstitial fluid)‬ ‭ uestion:‬‭Water is more vital to life than food because‬‭it provides the medium necessary for all‬ Q ‭chemical reactions and it is not stored in the body.‬ ‭a.‬ ‭True‬‭(Can live up to three weeks w/o food but only‬‭three days w/o water)‬ ‭b.‬ ‭False‬ ‭Body Mass Index (BMI)‬ ‭●‬ ‭BMI = weight in kg/(height in m)‬‭2‬ ‭●‬ ‭BMI = weight (lb)/(height in inches)‬‭2‬ ‭* 703‬ ‭●‬ ‭Underweight: < 18.5‬ ‭●‬ ‭Normal: 18.5-24.9‬ ‭●‬ ‭Overweight: 25.0-29.9‬ ‭‬ O ● ‭ besity, Class I: 30.0-34.9‬ ‭●‬ ‭Obestiy, Class II: 35.0-39.9‬ ‭●‬ ‭Extreme Obesity: 40.0+‬ ‭Factors Affecting Metabolic Rate (BMR)‬ ‭●‬ ‭The energy required to carry on the involuntary activities of the body at rest‬ ‭●‬ ‭Males have a higher BMR due to larger muscle mass‬ ‭○‬ ‭Men: BMR is about 1 cal/kg of body weight per hour‬ ‭○‬ ‭Women: BMR is about 0.9 cal/kg of body weight‬ ‭●‬ ‭Factors that increase BMR‬‭: Growth, infections, fever,‬‭emotional tension, extreme‬ ‭environmental temperatures, elevated levels of certain hormones‬ ‭●‬ ‭Factors that decrease BMR‬‭: Aging, prolonged fasting,‬‭sleep‬ ‭ uestion:‬‭A client is discussing weight loss with‬‭a nurse and says, “I will not eat for two weeks,‬ Q ‭then I will lose at least 10 pounds.” What should the nurse tell the client?‬ ‭a.‬ ‭What a good idea! Go ahead; that will jumpstart your weight loss.‬ ‭b.‬ ‭Many people find that to be an ideal way to lose weight quickly and easily.‬ ‭c.‬ ‭That will increase your metabolic rate and help you lose weight.‬ ‭d.‬ ‭That will decrease your metabolic rate and make weight loss more difficult.‬ ‭Calculating Caloric Requirements‬ ‭1.‬ ‭Multiply weight (lbs) by 10 for women and 11 for men‬ ‭2.‬ ‭Multiply usual activity level‬ ‭●‬ ‭1.2: Sedentary‬ ‭●‬ ‭1.3: Light activity, walking no more than 2 hours a day‬ ‭●‬ ‭1.4: Moderate activity, heavy housework, gardening‬ ‭●‬ ‭1.5: High activity, sports, labor intensive occupation‬ ‭Age-Related Changes Affecting Nutrition‬ ‭●‬ ‭Altered ability to masticate‬ ‭●‬ ‭Gastro-esoophageal reflux disease (GERD, hiatal hernia)‬ ‭○‬ ‭Decreased peristalsis in the esophagus‬ ‭●‬ ‭Slowed intestinal peristalsis‬ ‭○‬ ‭Caussed by muscle atrophy, decreased nerve transmission, slower cell division‬ ‭●‬ ‭Decreased gastric secretions‬ ‭●‬ ‭Lowered glucose tolerance‬ ‭●‬ ‭Loss of smell and taste‬ ‭○‬ ‭Caused by nerve degeneration‬ ‭●‬ ‭Reduction in appetite and thirst sensation‬ ‭●‬ ‭Anorexia (lack of appetite) associated with depression and loneliness‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ utritional deficiencies related to alcohol intake‬ N ‭Increased risk for drug-nutrient interactions‬ ‭Physical handicaps‬ ‭Low-income‬ ‭Assessment‬ ‭●‬ ‭Blood urea nitrogen (BUN): 7-20 mg/dL‬ ‭○‬ ‭If low, there is not enough protein‬ ‭●‬ ‭Serum albumin: 3.5-5.5 g/dL‬ ‭○‬ ‭If low, may indicate malnutrition‬ ‭●‬ ‭Hematocrit (Hct):‬ ‭○‬ ‭39-50% for men‬ ‭○‬ ‭35-45 for women‬ ‭●‬ ‭Hemoglobin (Hb):‬ ‭○‬ ‭13.5-17.5 g/dL for men‬ ‭○‬ ‭12-15.5 g/dL for women‬ ‭●‬ ‭Weight‬ ‭●‬ ‭Strength and activity tolerance‬ ‭●‬ ‭Healthy mucous membranes‬ ‭Nursing Interventions‬ ‭●‬ ‭Monitoring nutritional status‬ ‭○‬ ‭Assess the weight, food intake, and other parts of the body‬ ‭○‬ ‭Check for malnutrition or overnutrition‬ ‭○‬ ‭Monitor for issues such as obesity or anorexia‬ ‭●‬ ‭Teaching nutritional information‬ ‭○‬ ‭Educate about the importance of a balanced diet‬ ‭●‬ ‭Stimulating appetite‬ ‭○‬ ‭Factors including pain, illness, anxiety, and medications can alter eating patterns‬ ‭○‬ ‭Serve small and frequent meals‬ ‭○‬ ‭Make the food look more appealing‬ ‭○‬ ‭Offer alternatives if they refuse to eat‬ ‭●‬ ‭Assisting with eating‬ ‭○‬ ‭May be unable to eat by themselves due to physical/cognitive limitations‬ ‭○‬ ‭Create a respectful, comforting environment‬ ‭○‬ ‭Person-centered care, allow for autonomy‬ ‭ uestion:‬‭A nurse is feeding a client. Which of the‬‭following statements would help a person‬ Q ‭maintain dignity while being fed?‬ ‭a.‬ ‭I am going to feed you your cereal first, and then your eggs.‬ b‭ .‬ I‭ wish I had more time so I could feed you all of your meal.‬ ‭c.‬ ‭I know you don’t like me to feed you, but you need to eat.‬ ‭d.‬ ‭What part of your dinner would you like to eat first?‬ ‭Food Guide‬ ‭●‬ ‭Eg. 2000 cal diet/day‬ ‭●‬ ‭1 cup = 8 oz‬ ‭●‬ ‭Fruits: 2 cups‬ ‭●‬ ‭Grains: 6 oz‬ ‭●‬ ‭Vegetables: 2.5 cups‬ ‭●‬ ‭Meats and beans: 5.5 oz‬ ‭Providing Nutrition in Special Situations‬ ‭●‬ ‭Transitional diets after surgery or parenteral nutrition‬ ‭○‬ ‭Clear liquid diet: Clear liquids at room temperature, clear juice‬ ‭○‬ ‭Full liquid diet: Plus, milk, puddings, custards, vegetable juice‬ ‭○‬ ‭Soft diet: Regular diet without foods hard to digest or chew‬ ‭○‬ ‭Regular diet‬ ‭●‬ ‭After oral or facial surgery‬ ‭○‬ ‭Pureed diet: Blenderized liquid diet‬ ‭○‬ ‭Mechanical soft diet: Regular diet with modification for texture‬ ‭■‬ ‭Chopped, ground, or blenderized‬ ‭Question:‬‭A client has been prescribed a clear liquid‬‭diet. What food or fluids can be served?‬ ‭a.‬ ‭Milk‬ ‭b.‬ ‭Gelatin‬ ‭c.‬ ‭Vegetable juice‬ ‭d.‬ ‭Ice cream‬ ‭ roviding Enteral Nutrition: Short-Term Nutritional‬ P ‭Support‬ ‭●‬ ‭< 4 weeks, for dysphagia‬ ‭●‬ ‭Nasogastric (NG) tube‬ ‭○‬ ‭Liven tube: Firm and large‬ ‭○‬ ‭Dobhoff tube*: Small and soft‬ ‭○‬ ‭Not for GERD or gastric stasis‬ ‭●‬ ‭Nasointestinal (NI) tube‬ ‭○‬ ‭Dumping syndrome‬ ‭■‬ ‭Pyloric valve in the stomach regulates food → SI‬ ‭■‬ ‭Gas, bloating, nausea, diarrhea, cramping, and‬ ‭lightheadedness‬ ‭Confirmation of Tube Placement‬ ‭●‬ ‭Measurement of aspirate pH and visual assessment of aspirate‬ ‭○‬ ‭NG tube (pH < 5.5; tan, off-white, yellow or grassy green)‬ ‭○‬ ‭NI tube (pH > 7; bile-stained; yellow, brownish, greenish brown)‬ ‭●‬ ‭Carbon dioxide monitoring (CO‬‭2‬ ‭detector)‬ ‭○‬ ‭Possibility of going to the airway‬ ‭●‬ ‭Radiographic examination‬ ‭○‬ ‭Visual of the tube’s course‬ ‭○‬ ‭Exposure to radiation‬ ‭●‬ ‭Measurement and documentation of tube length‬ ‭○‬ ‭Reference point at the nostril‬ ‭Providing Enteral Nutrition: Long-Term Nutritional Support‬ ‭●‬ ‭Percutaneous endoscopic gastrostomy (PEG) tube‬ ‭○‬ ‭Abdominal wall to stomach‬ ‭●‬ ‭PEG/J tube‬ ‭○‬ ‭Abdominal wall into the jejunum through the stomach‬ ‭●‬ ‭Low-profile gastrostomy device (LPGD)‬ ‭○‬ ‭People who are active‬ ‭○‬ ‭Children‬ ‭Complications of Enteral Feeding‬ ‭●‬ ‭Aspiration‬ ‭●‬ ‭Clogged tube‬ ‭●‬ ‭Nasal erosion‬ ‭●‬ ‭Diarrhea‬ ‭‬ N ● ‭ ausea, vomiting, distention‬ ‭●‬ ‭Unplanned extubation‬ ‭●‬ ‭Stoma infection‬ ‭Providing Parenteral Nutrition‬ ‭●‬ ‭Administration of nutritional support via the IV route‬ ‭●‬ ‭Total parenteral nutrition (TPN)‬ ‭○‬ ‭Hypertonic (more concentrated than the plasma)‬ ‭○‬ ‭Central venous access device; cannot use peripheral line‬ ‭●‬ ‭Peripheral parenteral nutrition (PPN)‬ ‭○‬ ‭Isotonic, diluted‬ ‭○‬ ‭Components similar to those of TPN‬ ‭○‬ ‭Peripheral vein access‬ ‭Complications of Parenteral Nutrition‬ ‭●‬ ‭Insertion problems‬ ‭○‬ ‭At site or movement within the patient‬ ‭○‬ ‭Can lead to a blockage or air embolism‬ ‭●‬ ‭Phlebitis‬ ‭○‬ ‭Vein inflammation‬ ‭○‬ ‭IV catheter itself can irritate vein‬ ‭●‬ ‭Infection and sepsis‬ ‭○‬ ‭Infection at IV site or entrance of bacteria into the bloodstream‬ ‭●‬ ‭Fluid, electrolyte, and acid-base imbalances‬ ‭○‬ ‭Too much fluid → edema, HTN‬ ‭○‬ ‭Too little fluid → dehydration, low blood volume‬ ‭○‬ ‭Excess acid → decreased blood pH, difficulty buffering‬ ‭○‬ ‭Excessive bicarbonate → increased blood pH‬ ‭●‬ ‭Metabolic alterations‬ ‭○‬ ‭Hyperglycemia, altered carbohydrate metabolism‬ ‭○‬ ‭Hypoglycemia if abrupt discontinuation‬ ‭○‬ ‭Protein metabolism imbalance due to differing amino acids‬ ‭○‬ ‭Excessive infusion of lipids that can overwhelm the liver’s metabolizing ability‬ ‭●‬ ‭Liver and gallbladder disease‬ ‭○‬ ‭Cholystasis: Occurs with long-term PN‬ ‭○‬ ‭Hepaticsteatosis: Accumulation of fat in the liver‬ ‭○‬ ‭Gallbladder sludge: Bile not regularly emptied from the gallbladder‬ ‭●‬ ‭Used only when enteral intake is inadequate or contraindicated‬ ‭●‬ ‭Should be gradually discontinued ASAP‬