Transcript 26 basic nutrition and cultural considerations

Chapter 26
Concepts of Basic Nutrition and
Cultural Considerations
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 26
Lesson 26.1
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
1)
Review the structure and function of the
gastrointestinal system.
2)
Use the components of the USDA MyPlate
website to assist patients in planning their
diets.
3)
List medical conditions that may occur as a
result of protein, calorie, vitamin, or mineral
deficiency or excess.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Learning Objectives
Clinical Practice
1)
Identify patients at risk for nutritional deficits.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Overview of the Gastrointestinal System

Structures involved in
the digestive system
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Mouth
Teeth
Tongue
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Anus
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Accessory organs
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Salivary gland
 Liver
 Gallbladder
 Pancreas
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Slide 5
Figure 26-1: The gastrointestinal system
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Slide 6
Functions of the Organs of Digestion
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Mouth
First part of the digestive tract
Contains tongue and teeth and receives
secretions from the salivary glands
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Tongue composed of mostly skeletal muscle; the
most movable organ of the mouth
 Adults have 32 permanent teeth
• Cuspids, incisors, bicuspids, and molars
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Slide 7
Functions of the Organs of
Digestion (cont’d)
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Mouth
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Receives food and breaks it down into smaller
pieces; mixes food with saliva and starts the
digestive process
Parotid glands
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Largest salivary glands
 One on each side
 Located anterior and inferior to the ear
 Secrete saliva into the mouth
 Begins digestion of starches
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Slide 8
Functions of the Organs of
Digestion (cont’d)

Pharynx
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Connects the nasal and oral cavities to the
esophagus; food is forced into the pharynx by the
tongue
Esophagus

Muscular tube approximately 20 cm long
 Propels food into the stomach from the pharynx
using muscular contraction
 Lining secretes mucus
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Slide 9
Functions of the Organs of
Digestion (cont’d)
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Stomach
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Located in the upper-left quadrant of the
abdomen; has a capacity of approximately 1.5 L
 Has two sphincters
 Is a temporary storage place for food
 Mixes food with digestive juices
 Changes food into a semiliquid state
 Begins the digestion of proteins
 Absorbs vitamin B12
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Slide 10
Functions of the Organs of
Digestion (cont’d)
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Small intestine (duodenum, jejunum, ileum): mixes
food with secretions from liver and pancreas;
finishes digestion; absorbs nutrients
Large intestine (ascending, transverse,
descending, and sigmoid colon; rectum; anus;
cecum): absorbs fluid and electrolytes; eliminates
waste products
Liver and gallbladder: concentrate, store, and
secrete bile into the duodenum
Pancreas: secretes digestive juices; produces
insulin
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Slide 11
Effects of Aging on GI Tract
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Dental caries and tooth loss
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Decreased gag reflex
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Decrease a person’s ability to chew food
Increases the risk of aspiration
Decreased sense of taste
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May lead to loss of appetite
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Slide 12
Effects of Aging on GI Tract (cont’d)
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Decreased muscle tone at sphincters
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Decreased gastric secretions
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Increases risk of esophageal reflux
May interfere with digestion of food
Decreased peristalsis
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Increased risk of constipation
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Slide 13
Metabolism
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Process in which large molecules are broken
down into smaller molecules
Makes energy available to the organism
Enables absorbed nutrients to enter
bloodstream following digestion
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Digestion converts food into chemical substances
such as proteins and simple sugars to be used by
the body for energy production and cellular
metabolism
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Slide 14
Dietary Guidelines
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USDA MyPyramid
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Emphasizes fruits, vegetables, whole grains, and
fat-free or low-fat milk and milk products
Includes lean meats, poultry, fish, beans, eggs,
and nuts
Is low in saturated fats, trans fats, cholesterol,
sodium, and added sugars
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Slide 15
Protein
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Constant supply essential for rebuilding and
replacing body tissues
Plays a role in hormone production, fluid
balance, antibody production, and
transportation of nutrients
Supplies approximately 4 calories/g
Composed of amino acids


9 essential
11 nonessential
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Slide 16
Food Sources: Protein
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Animal sources
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Red meat, eggs, milk and milk products, poultry,
fish
Complete, or high-quality proteins
Plant sources

Grains, legumes, and most vegetables
 Incomplete, or low-quality proteins
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Slide 17
Food Sources: Protein (cont’d)
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Average DRI is 46 to 56 g of protein per day
for the healthy adult
Protein intake should be 10% to 15% of the
total daily calories
May vary depending on activity level, state of
health, and availability of protein food sources
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Slide 18
Proteins
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Protein deficiency
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Marasmus
• A form of protein energy and nutrient malnutrition
• Occurring chiefly in the first year of life, characterized by
growth retardation and wasting of subcutaneous fat and
muscle
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Kwashiorkor
• A condition occurring in infants and young children soon
after weaning from breast milk
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Slide 19
Proteins (cont’d)
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Protein excess
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Stressful to the liver and kidneys
• Kidneys must rid the body of excess waste products
• Liver function is strained with the excess load of protein
to metabolize
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Can lead to excess fat in the diet
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Slide 20
Vegetarian Diets
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Lacto-ovo-vegetarian
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Lactovegetarian
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Dairy products, eggs, and plant foods included in
the diet
Eggs are excluded; dairy products and plant foods
included
Vegan
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All animal food sources are excluded, including
honey
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Slide 21
Vegetarian Diets (cont’d)
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Well-planned vegetarian diets offer health
benefits
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Decreased risk of heart disease, hypertension,
diabetes, and obesity
Vegans may have a diet deficient in
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Vitamin B6, vitamin B12, iron, zinc, riboflavin, and
vitamin D
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Slide 22
Chapter 26
Lesson 26.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
4)
Discuss the function of proteins,
carbohydrates, fats, vitamins, minerals, and
water in the human body.
5)
Identify food sources of proteins,
carbohydrates, fats, vitamins, and minerals.
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Slide 24
Carbohydrates
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The body’s main source of energy
Should make up 50% to 60% of the daily diet
Supply 4 calories/g
Regulate protein and fat metabolism, fight
infection, and promote growth of body tissues
Three main types:

Simple, complex, and fiber
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Slide 25
Carbohydrates (cont’d)
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Simple carbohydrates
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Glucose is the metabolized form of sugar found in
the body and is found in:
Table sugar (sucrose), the major sweetener found
in foods
Fruit sugar (fructose)
Milk sugar (lactose)
Quickly absorbed into the bloodstream
Cause a quick rise in serum glucose
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Slide 26
Carbohydrates (cont’d)
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Complex carbohydrates
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Breads, pasta, cereals, and rice
Broken down into simple sugars for use by the
body
Provide a more consistent serum glucose level
than simple sugars provide
Recommended that 85% to 95% of consumed
carbohydrates are complex carbohydrates
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Slide 27
Carbohydrates (cont’d)
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Fiber
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The portion of the carbohydrate that cannot be
broken down during digestion
 Passes through the intestine undigested
 Increases bulk in the stool
 Aids in elimination
 May decrease absorption of fat
 Recommended intake 21 to 38 g/day
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Slide 28
Food Sources: Fiber
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Fruits
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Vegetables
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Green beans, broccoli, cauliflower, celery
Corn, potato (with skin), sweet potato
Grains and cereals
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Apples, bananas, oranges, grapefruits
Cantaloupe, strawberries
Breads, All Bran, oatmeal, Shredded Wheat
Legumes (cooked)
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Beans: kidney, pinto, lima; black-eyed peas
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Slide 29
Fats
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An essential nutrient
Supplies a concentrated form of energy
Supplies 9 calories/g consumed
Provides source of fatty acids
Adds flavor to foods and contributes to texture
Dissolves and transports fat-soluble vitamins and fat-soluble
phytonutrients (carotenoids)
Insulates and controls body temperature
Makes food smell appetizing
Cushions and protects body organs
Facilitates transmission of nerve impulses
Gives feeling of fullness after eating
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Slide 30
Fats (cont’d)
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Made up of fatty acids and glycerol
Fatty acids are classified as saturated or
unsaturated
Fatty liquids at room temperature are called
oils
Oils containing unsaturated fats:

Corn oil, safflower oil, canola oil
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Slide 31
Fats (cont’d)
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Omega-3 fatty acids
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The most unsaturated form of fatty acid
Found in salmon, halibut, sardines, tuna, canola
oil, soybean oil, chicken, eggs, and walnuts
Should be added to the diet as sources of
unsaturated fats
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Slide 32
Vitamins
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Essential nutrients that must be taken in
through food sources or supplements
Water-soluble vitamins
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Easily absorbed into the bloodstream for use by the
body
 B-complex vitamins and vitamin C
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Fat-soluble vitamins
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Absorbed in the small intestine the same as other fats
by action of bile in the duodenum and stored in the
liver
 A, D, E, and K
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Slide 33
Minerals
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Inorganic substances found in animals and
plants
Essential for metabolism and cellular function
Major minerals
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Calcium, magnesium, sodium, potassium,
phosphorus, sulfur, chlorine
Trace minerals
Iron, copper, iodine, manganese, cobalt, zinc,
molybdenum, selenium, fluoride, chromium
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Slide 34
Water
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Water is the most essential of all nutrients
Adult body is 50% to 69% water
Water requirement is 1 mL/calorie of intake
Used in every body process, from digestion to
absorption to elimination or secretion; large
amount must be stored in the body
General rule: intake needs to be equal to
recorded output plus 500 mL
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Slide 35
Question 1
Which nutrient is involved in all of the body’s
chemical processes and the most essential of
all nutrients?
1)
2)
3)
4)
Water
Protein
Sodium
Sugars
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Slide 36
Question 2
All of the following are functions of fats except
they:
1)
2)
3)
4)
provide a source of fatty acids.
add flavor to foods.
make food smell appetizing.
provide a quick source of protein.
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Slide 37
Question 3
Liz has an Orthodox Jewish patient. When
ordering her diet it is important to remember
that:
1)
2)
3)
4)
pork and pork products are allowed.
no alcohol is permitted.
shellfish are allowed.
meat and milk may not be mixed or eaten at
the same meal.
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Slide 38
Chapter 26
Lesson 26.3
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
6)
Identify a variety of factors that influence
nutrition.
7)
Explore cultural influences on nutrition
practices.
8)
Compare nutritional needs throughout life’s
stages.
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Slide 40
Learning Objectives
Clinical Practice
1)
Identify patients at risk for nutritional deficits.
(Continued from Lesson 26.1)
2)
Complete a nutritional assessment on an
assigned patient.
3)
Use therapeutic communication with a
patient while discussing needed diet
modification.
4)
Develop a teaching plan for the patient for
whom a therapeutic diet is prescribed.
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Slide 41
Factors Influencing Nutrition
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Age: infants, toddlers, preschool, school-age,
adolescents, adults, older adults
Illness
Emotional status
Economic status
Religion: Islam, Judaism, Seventh-Day Adventist
Culture: African American, Hispanic, Asian
Assessment, Nursing Diagnosis, Planning
Implementation, Teaching
Evaluation
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Slide 42
Nutritional Needs Through the
Life Span: Infants
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Should double birth weight by 6 months and
triple weight by 1 year
Breast milk recommended
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Formulas
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AAP recommends breast milk for first full year
Modified form of cow’s milk, made more digestible
with added carbohydrate and fat content
Solids introduced in diet at 4 to 6 months
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 43
Nutritional Needs Through the Life
Span: Toddlers and Preschool
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Ages 2 to 5 years
Consume less milk and increase intake of
solids
Provide small servings
Offer foods that are easy to chew
Avoid combination foods
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
Toddlers prefer single-item foods that do not touch
each other on the plate
Try colorful foods (e.g., peas, carrots)
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Slide 44
Nutritional Needs Through the Life
Span: Toddlers and Preschool (cont’d)
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Provide a pleasant environment at mealtimes
Provide plates and utensils in a size that can
be easily handled by a small child
Use dishes that are colorful and/or contain
pictures of favorite characters
Avoid forcing a child to eat
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Slide 45
Nutritional Needs Through the Life
Span: School-Age Children
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May desire sweet, non-nutritive foods such as
soda, candy, cake, and ice cream
Provide well-balanced breakfast before
school
Provide nutritious after-school snacks
High-calorie, high-sodium preferences may
predispose to obesity
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 46
Nutritional Needs Through the Life
Span: Adolescents
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Tend to consume many fast foods, either
from restaurants or vending machines
During growth spurt the body requires more
calories as well as nutrients
Adolescent females require increased levels
of iron after the menstrual cycle begins
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Slide 47
Nutritional Needs Through the Life
Span: Adulthood

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
Rely on fast foods and convenience foods
Obesity and hypertension prevalent
Have increased fat and sodium intake
Have increased sugar intake
Lack exercise
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Slide 48
Nutritional Needs Through the Life
Span: Older Adults
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Most at risk for inadequate nutrition
May need to decrease calories if activity level
is decreased
Physical limitations make food preparation
more difficult
Arrange for companionship during meals
Some older adults have limited incomes and
must limit food choices
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Slide 49
Question 4
Sandy works in a pediatrician’s office. A mother who brings in
her 9-month-old baby is asking nutrition advice and what an
appropriate weight would be for her infant. Which statement is
appropriate?
1)
2)
3)
4)
Most babies double their weight by the end of their first
year.
The American Academy of Pediatrics recommends breastfeeding for the first 6 months of life.
Nutrients found in formulas are easier to digest for babies
than breast milk.
Most babies double their weight by 6 months and triple it by
1 year.
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Slide 50
Question 5
Ashley’s patient has a body mass index (BMI)
of 16.5 for an adult male. This would mean her
patient is:
1)
2)
3)
4)
underweight.
overweight.
in the recommended range.
morbidly obese.
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Slide 51