Transcript Healthy People 2010 focus area

Nutrition
Chapter 44
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Elements of Energy and Nutrition
 Basal metabolic rate (BMR)
 Resting energy expenditure (REE)
 Nutrient density
 Nutrients: carbohydrates, proteins, fats, water, vitamins,
minerals
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Carbohydrates
 Produce 4 kcal/g
 Main source of energy
 Saccharides: simple and complex carbohydrates, fiber
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Proteins
 Produce 4 kcal/g
 Essential for growth, maintenance, and repair of body
tissue
 Amino acids: essential and nonessential
 Complete and complementary proteins
 Nitrogen balance
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Fats (Lipids)
 Produce 9 kcal/g
 Triglycerides and fatty acids
 Saturated or unsaturated: monounsaturated or
polyunsaturated fatty acids
 Essential or nonessential fatty acids
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Water
 Comprises 60% to 70% of body weight
 Cell function depends on a fluid environment
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Vitamins
 Essential to normal metabolism
 Fat-soluble: A, D, E, K
 Water-soluble: C and B complex
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Minerals
 Inorganic elements essential as catalysts in biochemical
reactions
 Macrominerals
 Microminerals or trace elements
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Digestive System
 Anatomy and physiology
 Digestion
 Absorption
 Metabolism and storage of nutrients
 Elimination
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Dietary Guidelines
 Dietary referenced intakes (DRI’s)
 Recommended range of intake
 Food guidelines: food guide pyramid
 Daily values
 Healthy People 2010 focus area
 Specific diets: diabetic, gluten-free, culturally specific
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Nutritional Needs throughout Growth
and Development
 Infants through school-age
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Breast-feeding
Formulas
Solid foods
Food habits
 Adolescents
 Eating disorders
 Activities
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Nutritional Needs throughout Growth
and Development (cont'd)
 Young and middle adults
 Pregnancy
 Lactation
 Older adults
 Less efficient systems
 Constipation, decreased absorption of nutrients
 Altered [diminished] sense of taste
 Chewing/swallowing problems
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Alternative Food Patterns
 Cultural and religious practices
 Vegetarian diets
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Assessment: Diet History
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Dietary intake and pattern
Symptoms
Allergies
Taste
Chewing and swallowing
Appetite
Elimination
Medications
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Assessment
 Anthropometry [Ht, Wt, measurement, BSA]
 Body mass index (BMI)
 Ideal body weight (IBW)
 Laboratory tests
 Clinical observations
 Client expectations
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Nursing Diagnoses
 Risk for aspiration
 Alteration in fluid/electrolyte balance
 Imbalanced nutrition: less than/more than body requirements
 Self-care deficit: Feeding
 Knowledge deficit
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Planning
 Goals and outcomes
 Client’s daily nutritional intake will meet his needs AEB…
 Client will lose ½ pound per week until…
 Pt will choose foods that meet his nutritional needs /fit
within dietary guidelines
 Education/ pt teaching
 Continuity of care – written plan
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Implementation:
Health Promotion
 Client education
 Meal planning
 Food storage and preparation safety
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Implementation: Acute Care
 Advancing diets
 Promoting appetite
 Assisting clients with feeding
 Enteral feeding
 Can’t ingest, can digest/eliminate
 Parenteral nutrition
 Can’t ingest/digest/eliminate [any or all]
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Enteral Feeding
 Nasogastric, jejunal, gastric tubes
 Insertion and verification of placement
 X-ray best; 2 other methods if no X-ray
 Types and preparation of formulas
 Complete or elemental, cal/ml ordered
 Complications
 Aspiration, occlusion, imbalances
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Parenteral Nutrition
 Initiation and management of insertion site [surgical
asepsis]
 PIV, PICC
 Types of solutions
 Dextrose, TPN, Lipids
 Rate of infusion – use pump
 Prevention of complications
 Emboli, sepsis, occlusion
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Implementation: Restorative Care
 Medical nutrition therapy for specific illnesses,
conditions, or injuries
 GI diseases [avoid irritants, eat often]
 Diabetes [carbs, limit fat, individualize]
 Cardiovascular diseases [limit salt, fat]
 Cancer [hi nutrient, flavor, digestibility]
 HIV [max nutrition, calories]
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Evaluation
 Short term: did pt. choose foods….
 ..eat breakfast… go to DR
 Long term: did pt. gain/lose wt?
 Revise goals as needed
 Teach pt/caregiver & involve to promote independence
and health
 Pass info to next setting [LTC]
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Questions?
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