Transcript Basic Human Needs Nutrition

Basic Human Needs
Nutrition
Nutrients: The Biochemical
units of nutrition
Body requires fuel to provide energy
for cellular metabolism and repair,
organ function, growth & body
movement
 Food is the fuel that keeps the machine
that is our body running
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Energy requirements based
on:
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Basal metabolic rate (BMR)-Energy needed to
maintain life sustaining ( Breathing, circulation,
temperature, heart rate)
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Resting Energy Expenditure (REE)-measurement that
accounts for BMR plus energy needed to digest food
& perform mild activity. Accounts for 60-70% of our
daily needs
Nutrients
Elements necessary for body processes
& function
 6 Categories
 Carbohydrates, Proteins, Fats, Water,
Vitamins, Minerals
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Carbohydrates
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Main source of energy (55-60% of calories in
diet)
Each gram = 4 kcal
Composed of carbon, hydrogen & oxygen
Main source of fuel (glucose) for brain,
skeletal muscle during exercise, RBC &WBC
production, cell function of renal medulla
Obtained from plant foods, except for lactose
(milk, sugar)
Simple Carbohydrates
Classified according to saccharides
 Monosaccharide- glucose(dextrose),
fructose, galactose (building blocks of
all other CHO)
 Glucose- blood sugar (normal fasting
BS=70-100 mg/ml)
 Disaccharide- sucrose, lactose, maltose,
 Sugar alcohols-sugar replacers
 Artificial sweetners
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Complex Carbohydrates
Polysaccharides are complex
carbohydrates
 Starches, glycogen, & fiber are
polysaccharides
 Starches are the major source of CHO
in diet (grains, cereals, breads, pasta,
starchy vegetables & legumes)
 Glycogen- animal starch (found in liver
& muscle tissue, provides immediate
fuel for muscle action
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Dietary Fiber
Plant foods that cannot be broken
down by body to digest
 Fiber eliminated by intestinal waste
 Adds volume, no fuel or energy
 Fiber in diet helps promote regularity
of bowel movements, helps in
regulating blood sugar, reducing
cholesterol, may promote weight loss,
reduce risk of colon cancer &
diverticular disease
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Functions of CHO
Provide fuel (CHO primary source)
 Spare body protein (body can convert
protein to glucose; body will break
down internal protein stores before fat
stores in absence of CHO)
 Helps prevent ketosis (partially broken
down fats accumulate in blood as
ketones)
 Enhance learning & memory (Glucose)
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Proteins
Provide a source of energy
 4 kcal per gram
 Essential for synthesis of body tissue in
growth, maintenance & repair
 Collagen, hormones, enzymes, immune
cells, DNA, RNA are composed of
protein
 Blood clotting, fluid regulation, & acidbase balance require protein
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Protein
Composed of carbon, hydrogen,
oxygen,& nitrogen
 There are essential and nonessential
amino acids
 Complete and incomplete proteins
 Essential amino acids: isoleucine,
leucine, lysine, threonine, tryptophan,
methionine, histidine, valine,
phenylalanine
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Protein
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Albumin & Insulin are simple proteins
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Lipoprotein is a complex protein (Lipid
& protein)
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Complete & Incomplete proteins
Protein
Nitrogen balance- intake & output of
nitrogen equal
 When intake of nitrogen exceeds
output, body is in a positive nitrogen
balance (growth, pregnancy,
maintenance of lean muscle mass &
vital organs, wound healing
 The extra nitrogen is used for building,
repairing, & replacement of tissues
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Protein
Negative Nitrogen balance- Body loses
nitrogen faster than it gains it
 Infection, Sepsis, Fever, starvation,
head injury, trauma, burns
 Increased nitrogen loss is the result of
body tissue destruction or loss of
nitrogen containing body fluids
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How protein functions in the
body
Provision of structure
 Growth & maintenance of tissue
 Regulation of body processes
(hormones, enzymes, nucleoproteins)
 Development of immunity
 Circulation of blood and nutrients
 Backup source of energy
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Fats
Fats(lipids) are the most calorically
dense
 Composed of carbon, hydrogen, &
oxygen (basic structural unit=glycerol)
 9 kcal per gram
 Composed of monoglycerides,
diglycerides, & triglycerides
 Lipogenesis- Synthesis of fatty acids
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Fats
Fatty acids can be Saturated or
Unsaturated, Monounsaturated, or
polyunsaturated & Trans-fatty acids
 Essential Fatty Acids (Linoleic,
Linolenic) must be supplied by diet
 Nonessential fatty acids
 Necessary for metabolic processes
 HDL vs LDL
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Fats
Animal fats are high in saturated fatty
acids
 Vegetable fats are high in unsaturated
and polyunsaturated fatty acids
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Functions of Fats
Fuel source
 Vehicle for fat soluble vitamins
 Satiety value
 Sources of essential fatty acids
 Organ protection
 Lubrication
 Insulation
 Cell membrane structure
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Cholesterol
Not a true fat, classified as a sterol
 Body manufactures 1000 mg day
 Component of bile salts, essential
component of cell membrane,
necessary for production of several
hormones (cortisone, estrogen
adrenaline, testosterone)
 Elevated blood levels is a major risk
factor for CAD ( < 200 mg/dL optimal)
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Water
Critical component of body
 Cell function depends on a fluid
environment
 60-70% of body weight
 Muscle contains more water than fat
 Infants have higher total body water
 Fluid needs met by ingesting fluids &
solid food high in water content (fruits
& veggies)
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Vitamins
Organic substances present in small
amounts in food
 Essential for normal metabolism
 Body depends on dietary intake
 Vitamin content higher in fresh foods
 Classification by solubility: water or fat
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Vitamins
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Fat Soluble- Vitamins A, D, E, K
Can be stored in body
Provided through dietary intake except for
Vitamin D
Antioxidant role of vitamins
Water Soluble-Vitamin C, B Complex (8
vitamins)
Cannot be stored in body, provided by
dietary intake
Vitamins are catalysts in biochemical
reactions
Functions of Fat-Soluble
Vitamins
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Vitamin A: vision, healthy epithelial tissue,
proper bone growth, energy regulation
Vitamin D: promotes normal bone
mineralization, plays a role in calcium and
phosphorus absoprtion
Vitamin E: antioxidant role (protects Vitamin
A & unsaturated fatty acids from oxidation
Vitamin K: blood clotting, bone metabolism
Functions of Water-Soluble
Vitamins
Vitamin C: collagen synthesis, powerful
antioxidant, adrenal gland function,
iron absorption, folic acid conversion
 B-Complex: co-enzyme in numerous
metabolism mechanisms
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Minerals
Inorganic elements essential to the
body as catalysts in biochemical
reactions
 Macrominerals-Body requires 100mg or
more
 Trace elements-Body needs less than
100 mg
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Minerals
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Macrominerals- Calcium, Sodium,
Potassium, Phosphorus, Magnesium,
Sulfur, and Chloride
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Trace Elements- Iodine, Fluoride, Iron,
Selenium, Zinc, Copper, Selenium,
Manganese, Chromium
A & P of Digestion
Mechanical breakdown that results
from chewing, churning, mixing with
fluid, & chemical reaction till food
reaches it’s simplest form
 Enzymes speed up chemical reactions
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A & P of Digestion
Dysphagia- Difficulty swallowing
 Absorption occurs in small intestineprimary absorption site for nutrients
 Main source of water absorption via
intestine, small intestine reabsorbs
9.5 L
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Metabolism
Catabolism- Breakdown of biochemical
substances into simpler substances
(starvation)
 All body cells except RBC & neurons
can oxidize fatty acids into ketones for
energy in the absence of dietary CHO
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Metabolism
Biochemical reaction with cells
 Anabolic or Catabolic
 Anabolism- Building of more complex
substances, occurs when lean muscle is
added through diet & exercise
 Amino acids are anabolized into tissue,
hormones, & enzymes
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Dietary Guidelines
Recommended dietary allowances
 Food Guidelines-Food Pyramid
 Daily values on food labels (based on
2000 kcal/day)
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Nutrition during Growth &
Development
Infant
 School Age
 Adolescents
 Young-Middle Adults
 Older Adults
 Alternative food patterns
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Nursing Process & Nutrition
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Assessment- Anthropometry
Body Mass Index
Ideal Body Weight
Anthropometric measurements
Labs- Albumin, Transferrin, Prealbumin, Protein,
Hgb, Total Lymphocyte Count
Nitrogen balance
Dietary & Health history
Clinical Observation
Nursing Diagnosis
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You tell me!!!!!!
Conditions affecting Digestion
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CVA
GERD
Hiatal Hernia
Gastric Bypass
H-Pylori
Ulcers
Obstruction
Gallbladder
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Malabsorption
syndromes
Lactose Intolerance
Celiac disease
IBS
IBD (colitis, Crohns)
Diverticulosis
Diarrhea/Constipation
Hemorrhoids
Implementation
Acute Care
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Oral delivery of nutrients
Enteral tube feedings
Nasogastric, jejunal, gastric tubes
Less risk for aspiration with jejunal feedings
Indicated in cancer of neck, upper GI tract, GI
disorders, CVA, dementia, Inadequate oral intake
Parenteral Nutrition
Tube Feeding
Nsg Responsibilities
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Document baseline weight
Check Tube placement
Check residual q 4 hr
Check labs
I&O
Daily weight
Aspiration Precautions
Water Flush
Check for complications
Enteral Feeding Complications
Pulmonary aspiration
 Diarrhea
 Constipation
 Tube occlusion
 Tube displacement
 Delayed gastric emptying (check
residual)
 Nausea/vomiting/cramping
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Enteral Feeding Formulas
Osmolite
 Perative
 Pulmocare
 Jevity
 Nepro
 Hepataid
 Glucerna
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Enteral Access
Nose-nasogastric (Levine, Dobhoff,
Flexiflo)
 Surgically placed- gastroscopy,
jejunostomy
 Endoscopically- Percutaneous
endoscopic gastroscopy (PEG)
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Parenteral Nutrition
Specialized nutrition support in which
nutrients are provided intravenously
 Requires nutritional assessment,
placement of CV line, careful
monitoring for complications
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Parenteral Nutrition
Clients who are unable to digest or
absorb enteral nutrition benefit from
TPN (Total parenteral nutrition)
 Clients highly stressed physiologically
(burns, sepsis, head injury) also benefit
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Parenteral Nutrition
Goal is to move back to GI route
 Adding lipids provides supplemental
kcals & provide essential fatty acids
 10% - 20% Dextrose can be given
peripherally (PPN)
 >20% Dextrose requires CV line or
PICC line
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TPN Monitoring
Daily Weight
 BGM every 6 hours
 Vitals & temp every shift
I & O
 Labs
 Dedicated line for infusion
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Nursing Implications
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TPN intravenous line requires a filter
Dedicated line for infusion
IV tubing changed every 24 hours
Requires IV pump administration
Formulas prepared by pharmacist and doubled
checked by RN
Special physician order sheet
10% Dextrose solution used as substitute if TPN not
available
TPN Complications
Pneumothorax from CV line insertion
 Infection of CV line
 Air embolism
 Lyte & mineral imbalances
 Concentrated glucose administration
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Implementation
Patient Education
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Special diets may be necessary GI disorders-Ulcer
disease, IBD, Crohns, Malabsorption Syndrome,
Diverticulitis, Celiac disease
Diabetes (ADA diets)
CV Disease & CVA
Pulmonary Disease
Renal Disease
Cancer
HIV
Usual Diet Progression
NPO
 Clear Liquid
 Full Liquid
 Pureed
 Mechanical soft
 Soft
 Regular
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