Transcript Nutrition
Stressors that affect Nutrition NUR101 FALL 2008 LECTURE # 24 K. BURGER, MSED, MSN, RN, CNE PPP By Sharon Niggemeier RN MSN Revised 12/08 J Borrero Nutrition • Nutrition is interaction between an organism and the food it consumes • Food & eating is a basic need, affects health • Various factors affect nutrition • Nutrients – substances used by the body for growth & development • Role of nurse to teach, guide and inform on the importance of proper nutrition Nursing Assessment • • • • • • Dietary intake and food preparation Unpleasant symptoms Allergies Taste, chewing and swallowing Appetite and weight Use of medications Nutritional health-care Team • • • • • • • MD Nurse Social Worker Physical Therapist Occupational Therapist Speech Pathologist Pharmacist Essential Nutrients • • • • Water Carbohydrates Proteins Lipids Regulatory Nutrients • Vitamins • Minerals Water • Water: present in every cell • Absorbed in small /large intestine • Metabolized carbohydrates, proteins, lipids produce water • Dietary intake from fluids and solid food provide water • Function: fluid medium needed for all chemical reactions in the body Carbohydrates • Carbohydrates: simple or complex • Digested by enzymes (amylase/lactase) • Absorbed in small intestine • Metabolized into glucose which is used for energy or stored…Stored as either glycogen or fat • Function: provide energy, spare proteins Carbohydrates (CHO) • Carbon – Hydrogen-Oxygen • 1 gram carbohydrate = 4 Kcal • Monosaccharides – simple sugars glucose, fructose, galactose • Dissaccharides – double sugars sucrose, lactose, maltose • Polysaccharides – complex forms starch, glycogen, cellulose (fiber) • Recommended intake: 60% of total Kcal (300g) Fiber 25-30g daily Carbohydrates • What are some other functions of carbohydrates in our bodies? Laxative effects of: DIETARY FIBER Helps regulate blood sugar Lactose Cellulose May reduce risk of hyperlipidemia May reduce risk of some cancers Protein • • • • • Proteins: composed of amino acids Digested by enzymes (proteolytic) Absorbed in small intestine Metabolism includes: Anabolism=Catabolism: Nitrogen balance • Function: maintain body tissue and tissue growth Protein (CHON) • Carbon-Hydrogen-Oxygen- Nitrogen • 1 gram of protein = 4 Kcal • Comprised of 22 amino acids which can be comined by body to form over 1000 types of proteins • 9 essential amino acids – body cannot synthesize them • Complete protein = one with all 9 essential amino acids (animal sources and soy) • Incomplete proteins = contain some but not all essential (plant sources) • Complementary proteins = 2 proteins that when combined provide all essential amino acids. • Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs) Proteins (CHON) • What are some other functions of proteins? Fluid Balance Ex: Albumin Energy ( last resort) De-amination / Nitrogen stripped from CHON to create glucose CHO Lipids • Lipids: insoluble in water • Digested by enzymes (lipase,bile) in stomach and small intestine • Absorbed in small intestine • Metabolism includes conversion (by liver and small intestine) into soluble compounds called lipoproteins • Function: energy, insulates body, absorption (fat-soluble vitamins) Lipids (Fats) • • • • • • Carbon-Hydrogen-Oxygen 1 gram of Fat = 9 Kcal Composed of fatty acids: (linoleic&linolenic =essential) Saturated fat = mostly animal source Unsaturated fat = mostly plant and fish sources Triglyceride = fat in bloodstream /storage form of fat in body. • Trans Fat = hydrogenated fats in processed foods • Recommended intake: 20-35% of total Kcal Lipids • Lipoproteins - made by the body to move waterinsoluble lipids (such as cholesterol) thru the bloodstream • LDL (low density lipoprotein)- major carrier of cholesterol. Function is to transport cholesterol from liver into circulation. “Bad cholesterol” • HDL (High density lipoprotein) - carries cholesterol away from tissue to liver ..high levels decrease atherosclerosis. “Good cholesterol” • Cholesterol- not essential from diet as the body produces enough. Desirable Blood Lipid Levels • • • • Total Cholesterol Triglycerides LDL HDL < 200 < 150 < 100 > 40 Male > 50 Female • Elevated Blood Lipid Levels (Hyperlipidemia) = increased risk for CHD, Hypertension, Stroke, MI Vitamins • Vitamins: required in small amounts • water- soluble: absorbed through intestine directly into blood stream (C, B complex folic acid) • fat-soluble: absorbed with lipids into lymphatic circulation (A,D,E,K) • Function: needed for metabolism of carbohydrates, lipids & proteins Water-soluble vitamins text review Vitamin C (ascorbic acid) • Function: collagen formation (wound healing), antioxidant, immune system • More prone to deficiency; not stored • Deficiency: bleeding gums, scurvy, poor wound healing • Source: citrus fruits, tomatoes, broccoli Vitamin B Complex : thiamine, riboflavin, niacin, B6, B12 • Function: metabolism of carbs, lipids and proteins • RNA, DNA synthesis (folic acid) & heme formation (B12) • Deficiency:beriberi, poor wound healing, anemia, pernicious anemia • Sources: Whole grains Organ meats Vitamin B12 (continued) Vitamin B12 (cobalamine) • Important for hemoglobin synthesis • Very little found in vegetable sources (unlike other B Vitamins) • Pernicious anemia = B12 deficiency or lack of intrinsic factor for B12 absorption. Susceptible population = Total Vegan Clients w/ decreased gastric acid secretion (gastric bypass, stomach cancer) • Rx = B12 injections Folic Acid Folic Acid (Folate) • Folic Acid Deficiency leads to elevated Homocysteine levels which are associated with increased risk for CHD. • Folic Acid Deficiency linked to neural tube defects – Spina Bifida • Natural folate (in foods) only ½ as available to body as supplement folic acid • 1998 = mandatory fortification of breads/grains • Supplements recommended for: women of child-bearing age, gastric surgery, malabsorption (alcholic) Fat-soluble Vitamins text review • Vitamin A: function- visual acuity, skin maintenance…deficiency-night blindness Dark green leafy vegs, yellow/orange vegs • Vitamin D: function-calcium absorption… deficiencyrickets, bone malformation Fortified milk, ultraviolet light • Vitamin E: function-antioxidant, heme synthesis…deficiency-RBC hemolysis Whole grains, nuts • Vitamin K: function-formation blood clotting proteins…deficiency- hemorrhage Dark green leafy vegs, synthesized by bacteria in sm intestine • More prone to toxicity; stored by body Minerals • Minerals: macrominerals or microminerals • Originate in earth’s crust, aren’t digested or metabolized. Combine to form salts or organic compounds. Always retain their chemical properties. • Function: provide structure within the body (bones/teeth, F/E and acid /base balance, nerve transmission, muscle contraction) Macrominerals text review • Calcium: bone/ teeth formation, blood clotting, nerve transmission…deficiency-tetany, osteoporosis • Phosphorous: bones, acid-base balance…deficiency- muscle weakness • Magnesium: bones, metabolism ...deficiencymuscle pain, poor cardiac function • Potassium: f/e balance, acid-base balance… deficiency-muscle cramps , irregular ht. rate Microminerals text review • Iron: hemoglobin formation…deficiency-anemia • Iodine: thyroid hormones…deficiencygoiter • Zinc: wound healing … deficiencyimpaired immune system • Fluoride: teeth/bones…deficiencydiscolored tooth enamel Energy Balance • Kilocalorie- unit of heat; measures the energy in the diet • Basal metabolic rate (BMR)- amount of energy needed for all the biochemical processes to occur when the body is at rest. • Proper nutrition provides the energy needed to maintain health Body Weight Standards • Ideal body weight IBW = balance of energy used by the body and intake of nutrients • Rule of thumb Women: 100 lbs lst 5ft 5 lbs/inch over 5ft Men: 106 lbs lst 5 ft 6 lbs/inch over 5ft • Standardized charts Overweight = 10% > chart Obese = 20% > chart • Body mass index(BMI) 18.5 – 24.9 healthy > 25 = overweight > 30 = obese > 40 = morbidly obese Calculate your BMI Weight (lbs) X 705 Height (inches) squared Factors Affecting Nutrition • Developmental • Gender • Ethnicity & culture • Food beliefs • Preference • Religion Factors Affecting Nutrition • Lifestyle • Medications & therapy • Heath status • Advertising • Alcohol Consumption • Psychological factors Adequate Nutrition • Food Guide Pyramid • Daily reference intake • Food Labeling • Dietary guidelines Dietary Guidelines • • • • • • Balance / Moderation / Variety Maintain healthy weight Exercise Eat a variety of foods in moderation Low sodium / Low fat / Low simple sugars Alcohol in moderation Assessing: Nutrition • • • • • • Nursing history Physical exam 24-hr. recall Food records Anthropometic data Lab tests – Albumin & Prealbumin Hemoglobin Transferrin Nursing Dx • Imbalanced nutrition: less than body requirements R/T NPO status AEB height 5’6’’ wt 105 lbs., pt. states “ I’ve never been this skinny before, my clothes are hanging off of me” • Impaired dentition R/T nutritional deficits AEB dentures not fitting properly Planning- outcome criteria • • • • Pt. will: Attain and maintain ideal body weight Eat a variety of foods at each meal Promote healthy nutritional practices Interventions • Monitoring food intake • Assist with feeding • Stimulate appetite • Teaching Diet Restrictions • Low residue- no seeds, • NPO raw vegetables or • Clear liquids-see fruits, whole grains through (broth, • High fiber- raw fruits, apple juice) grains, vegetables • Full liquids –foods • Sodium restricted: that turn to liquid at – Mild 2 gram Na/day room temp. – Moderate 1gram – Strict 500mg (shakes, milk) – Severe 250 mg • Soft –easily chewed – DASH Dietary Approaches and digested to Stop Hypertension Diet Restrictions • Calorie restrictions • Diabetic diet • Cholesterol • Food textures:Thick it • Thin • Nectar-like • Honey-like • Spoon-thick Enteral Nutrition • Used when oral intake is inadequate, swallowing difficulty, coma • Tube passed into gastrointestinal tract to deliver nutrients • Maintains GI integrity preferred over parental feedings (via veins) Enteral Nutrition • Short term use • Nasogastric • Nasointestinal • Long term use • Gastrostomy • Percutaneous endoscopic gastrostromy (PEG) Enteral Formulas • Many types of formulas • Administered continuous or intermittent • Use pumps to monitor intake • Monitor Intake & Output Enteral Precautions • Prevent aspiration – Position fowlers/high fowlers – Assess placement…check pH – Note residual – Auscultate bowel sounds Enteral Precautions • Preventing complications include: • • • • • Clogged tube Nasal erosion Diarrhea Infection Dislodgement Parental Nutrition • Bypasses GI tract, nutrition administered IV, more complicated • Total parental nutrition (TPN) also called (hyperalimentation)…central line • Partial parental nutrition (PPN)..PICC line Evaluation • Use established outcomes to evaluate the pt’s response to care • Pt understanding of therapeutic diet • Reassess S&S associated with altered nutrition (wt, intake, lab results) • Determine pt’s satisfaction with nutritional therapy Summary • Nurses role, to understand nutrients and how they affect nutrition • Various factors affect one’s nutritional status • Interventions include numerous diets, assisting with feeding, monitoring and teaching • Nutrition can also be administered enterally or parentally