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Fundamentals of nursing
PNU 145
Chapter 15
Nutrition
Cheryl Proffitt MSN,RN
October,2013.
Nutrition
• Objectives
• Define nutrition and malnutrition
• List six components of basic nutrition
• List at least five factors that influence nutritional needs
• Discuss the purpose and components of the myplate food
guidelines
• Discuss three facts available on nutritional labels
• Explain protein complementation
• Identify four objective assessments for determining a person’s
nutritional status
• Discuss the purpose of a diet history
Objectives Cont’d
• List five common problems that can be identified from a
nutritional assessment
• Plan nursing interventions fro resolving problems caused
or affected by nutrition
• List seven common hospital diets
• Discuss four nursing responsibilities for meeting clients
nutritional needs
• Identify three facts a nurse must know about a client’s diet
• Describe and demonstrate techniques fro feeding clients
• Explain how to meet the nutritional needs of clients with
visual impairments or dementia
• Discuss at least three unique aspects of nutrition that
apply to older adults.
Nutrition
• Nutrition is the process by which the body
uses food
• Malnutrition is a condition resulting from a
lack of proper nutrients in the diet. It is
chronic inadequate nutrition
Who Is at Risk of Malnutrition
• Malnutrition is common among people living
in developing countries. Is lack of proper
nutrients in the diet. Common amongst poor
as well as affluent countries
• In the U.S.:
– Older adults who are socially isolated or
living on fixed incomes
– Homeless people
– Children of economically deprived parents
Who Is at Risk of Malnutrition (cont’d)
• In the U.S. (cont’d):
– Pregnant teenagers
– People with substance abuse problems
such as alcoholism
– Clients with eating disorders, such as
anorexia nervosa and bulimia nervosa
Basic Nutrients
• All humans have basic nutritional needsresearchers recommend the following:
• Calories: energy value of food
• Proteins: building blocks of the body,
composed of amino acids, builds and repairs
cells
• Carbohydrates: source of quick energy
• Fats: concentrated energy source
– Saturated fats: generally solid
– Unsaturated fats: healthier form of fat
Basic Nutrients
• Minerals: non-caloric substances that
regulates chemical processes
• Vitamins: normal growth, maintenance of
health, and functioning of the body
Water-soluble vitamins: eliminated with
body fluids
Fat-soluble vitamins: stored in the body as
reserves for future needs
• Water: Necessary for life
Health Risks related to Fat and Cholesterol
• Excess fat intake is related to heart disease,
hypertension, diabetes, and some cancers.
• The goal of the government is for at least
50% of people 2years and older to consume
no more than 29.8%of their daily calories
from fat
• The American heart Association (AHA,2010),
indicates that consumption of trans fat ( fats
that has been processed and hydrogen
added), increases the risk for coronary heart
disease.
Risks Associated With Cholesterol
Vitamins
(Refer to Table 15-3 in the textbook.)
Nutritional Strategies
1. Healthy people, 2020 providing recommendations to
enhance nutrition and weight status.
2. Using the US department of agriculture my plate,
referring to labels about nutrition. Myplate introduced in
2011,replaced the food pyramid.( it is color coded to
show the five groups of food to be consumed each day)
3. It displays the recommended five food groups that
promotes healthy nutrition
My Plate
• Amounts from
various food group
categories can be
individualized
according to a
person’s age,
gender, and level
of activity
Grain
Vegetables
30%
Fruits
30%
Proteins
20%
20%
Low/non-fat milk,
other dairy products
Nutritional Labels
•Tells- Amount of each nutrient
per serving, using household
measurements e.x gm, mg
•Must provide printed disease
prevention guidelines
Nutrition labels
• We need to know the daily value .DV- daily valuecalculated in % based on standard set for total fat,
saturated fat, cholesterol, sodium, carbohydrate, and
fiber in a 2000cal diet. The standards are as follows
• Total Fat: less than 65g
• Saturated Fat: Less than 20g
• Cholesterol: Less than 300mg
• Sodium: Less than24oomg
• Total carbohydrate: 300g
• Dietary fiber: 25g
• People consuming diets more than 2000cal, must adjust
the % of daily value.
Nutritional Labels (cont’d)
•The federal Nutrition Labeling and
Education Act states that
companies should comply with
standard definitions if they use
health-related claims for, example
low fat.
Nutritional Label Examples of
regulations for labeling terms.
Factors That Influence
Nutritional Needs
1.Influence on eating Habits.
2. Vegetarianism
Influence on Eating Habits:
• Food preferences acquired during childhood
• Established patterns for meals
• Attitudes about nutrition,
• Knowledge of nutrition
• Income level, Time available for food preparation
Factors that Influence
Nutritional Needs (cont’d)
Influence on eating (Cont’d)
• Number of people in the household
• Access to food markets
• Use of food for comfort, celebration, or
symbolic reward
• Satisfaction or dissatisfaction with body
weight
• Religious beliefs
Factors that Influence Nutritional Needs
(cont’d)
• Vegetarianism
 Are people who restrict their consumption of animal food
sources.
 They modify their diet for religious or personal reasons
 It is practiced in various forms an example is vegans (
(rely on plant sources for protein).
 Semi-vegetarian exclude only red meat
 Advantages of vegetarians: low incidence of colorectal
cancer, fewer problems with obesity and diseases.
Protein Complementation
• Protein complementation involves eating a
variety of incomplete plant protein over the
course of the day to provide adequate
amounts and proportions of all the essential
amino acids; found in animal sources
• Examples: see next slide for guide
Protein Complementation (cont.)
Nutritional Status Assessment
• Nurses identifies current or potential client problems
associated with nutrition.
• Nurses obtain subjective data by asking client focused
questions on a diet history
• Nurses obtain objective data using physical assessment
techniques.
Objective Data Assessment
• So how.
• Physical assessment: assessment of
physique and general well-being
• Laboratory data: used in nutritional
assessment . Cholesterol
• Anthropometric data: are measurements for
body size and composition, by measuring
height and weight and calculating body-mass
index (BMI)
BMI Cont’d
• (BMI )Body mass index- provides numeric data to
compare a person’s size in relation in relation to
established norms for the adult populationcalculated using height and weight).(box 15-4)
• Mid-arm circumference:- helps to determine skeletal
muscle mass
• Triceps skinfold measurement:- additional data for
estimating the amount of subcutaneous fat
deposits.( fig 15-6)
• Abdominal measurement:_ measurement of fatty
tissue
Diet History/Subjective data
• How to
• Assessment technique for obtaining facts about
a client’s eating habits and factors that affect
nutrition, such as level of appetite, weight loss
or gain of 10 lbs in the past 6 months, and
number of meals the client eats per day, food
Likes and dislikes, Alcohol consumption, special
diets, use of over the counter drugs. Vitamins or
mineral supplements. The desire to improve
nutritional intake or to gain or loose weight.
Management of problems interfering with
Nutrition
Imbalanced nutrition:
less than body
requirements
Imbalanced nutrition:
more than body
requirements
Deficient knowledge:
nutrition
Self-care deficit:
feeding
Impaired swallowing
Risk for aspiration
Other Problems interfering with
Nutritional
• Obesity-A person’s BMI exceeds 30 or trifold
measurement exceeds 15mm.
• Emaciation-Prolonged weight loss, or
excessiveness leanness,or cachexia general
wasting away of the body tissue.
• Anorexia- Loss of appetite due to sickness
• Nausea-usually preceeds vomiting.
• Vomiting- Loss of stomach contents through
the mouth.
Other Problems interfering with
Nutritional ( Vomiting Cont’d)
• Emesis- or vomitus ( substance vomited)
• Retching- the act of vomiting without
producing vomitus.
• Regurgitation-bringing stomach contents to
the throat and mouth without the effort of
vomiting
• Projectile vomiting- vomiting that occurs
with great force, is associated with certain
diseases.
Other Problems interfering with
Nutritional
• Stomach gas- results from swallowing
air
• Eructation- ( Belching) discharge of gas
from stomach
• Flatus – Gas formed in the intestine/
released from the rectum.
Hospital Diets
• Common hospital Diets includes:
• Regular or general: allows unrestricted food
selections
• Light or convalescent: differs from regular
diet in preparation; typically omits fried,
fatty, gas-forming, and raw foods and rich
pastries
Hospital Diets (cont’d)
• Soft: contains foods soft in texture; usually
low in residue and readily digestible;
provides fewer fruits, vegetables, or meats
than a light diet
• Mechanical soft: resembles a light diet but
used for clients with chewing difficulties;
provides cooked fruits and vegetables and
ground meats
Hospital Diets (cont’d)
• Full liquid: fruit and vegetable juices;
creamed or blended soups; milk, ices, ice
cream, gelatin, junket, custards; and
cooked cereals
• Clear liquid: water, clear broth, clear fruit
juices, plain gelatin, tea, and coffee; may or
may not include carbonated beverages
• Special therapeutic: foods prepared to meet
special needs, such as low in sodium, fat, or
fiber
• Health care agencies having a dietician
Management of Nutrition
• Meal Trays: meals served at bedside or dining
rooms or cafeterias
• Feeding Assistance- assistance with eating, and for
clients with dysphagia ( difficulty swallowing).
Remain with the client throughout eating. Place
client in sitting position. Encourage the client to eat
slowly. Limit distracting stimuli. Give short, simple
instructions to prompt the client to eat and swallow
• Feeding a visually impaired client
• Place towel across the clients chest, Arrange for
finger foods, use dishes with rims.
Management of Nutrition
• Feeding clients with dementia (
deteroriation of previous intellectual
capacity)
• Have the same staff help the client
• Be consistent with the time and place for
eating
• Place the food try close to the client
• Guide the hand and food to the client’s
mouth
Nursing Responsibilities
• Ordering and canceling diets for clients
• Serving and collecting meal trays
• Helping clients to eat
• Recording the percentage of food that
clients eat
Older Adults
• Evaluation of nutritional status in annual
examinations or more frequently
• Diminished senses of smell and taste;
require fewer calories; nutritional
supplements should be evaluated; if
sedentary, teach benefits of exercise; oral
and dental problems
• Chronic conditions; food–drug interactions;
poor intake due to ill fitted dentures,
encourage adequate fluid intake.
Gerontological Considerations cont’d
• Dysphagia among older adults often results
from neurological conditions including
stroke, esophageal disorders, or increased
pressure from abdominal disorders.
References
Timby, B. (2014). Fundamental nursing skills and concepts (11th
ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Google pictures. (2015, August 10). Retrieved from
http://www.google.com