Transcript Nuitition
Nutrition – Chapter 30 Learning objectives Identify nutrition and fluid intake and output requirements across the lifespan Describe nutrition and fluid balance Identify types of nutrients Explain roles of nutrients in the body Identify food sources for nutrients Learning objectives Explain types of therapeutic diets Explain the relationship of prescribed diet to nutritional/fluid balance Identify equipment for measuring nutrition and fluid intake and output Calculate nutritional/fluid intake and output Learning objectives Define enteral feedings Explain the procedure for initiating enteral feedings and equipment used Nutrition – You Are What You Eat Nutrition – the food you eat and how your body uses it Nutrients – chemical substances supplied by food that the body needs for growth, maintenance and repair Macronutrients – carbohydrates, fats, and proteins Nutrition Nutritional status is determined: By what & how much the individual eats By his or her’s body ability to use nutrients By the state of the person as a result of the intake of nutrients Factors Affecting Eating Culture Religion Socioeconomic Personal Preference Childhood Emotions Health Diet & Illness Some of our nation’s top leading causes of death have been associated with diet: Coronary heart disease Certain types of cancer Stroke Diabetes Atherosclerosis Nutrition - Purpose 1. Provide energy for body processes & movement 2. Provide structural material for body tissue 3. Regulating body processes Nutrients CHO, fats are well known as fuel foods – but protein is sometimes forgotten CHO – 4Kcal/gm FAT – 0 Kcal/gm Protein – 4 Kcal/gm Simple vs Complex Carbohydrates Simple: Monosaccharides: Glucose, fructose, galactose Simple CHO Disaccharides : Double sugar Sucrose, maltose, lactose W & B Sugar, molasses, honey, sweet potatoes, pineapples, carrots Complex CHO Polysaccharides Starches Fiber Complex - Polysaccharides Starches – Large molecule of glucose Requires longer to digest Glucose available slower Ex: Cereal grains, corn, peas, potatoes, squash, legumes Lipids -- Fat Classified According to three Criteria: Whether the fat is emulsified or nonemulsified Visible or invisible Simple or Compound Visible vs. Invisible Fats Visible Fat: 40% Easily seen on meat Oil Butter Invisible Fat: Hidden in foods Egg yolk Baked goods Snacks Emulsified milk Cheese Olives Nuts Avocados Fats Provide: Energy Insulation Cell membrane integrity Nerve impulse transmission Carries fat soluble vitamins (ADEK) Taste (satiety) Fatty Acids Saturated: One whose structure is completely filled with all H+ it can hold Heavier, more dense,more solid Requires higher Temp. to melt Unsaturated: Has at least one unfilled H+ spot Monounsaturated vs Polyunsaturated The more unsat. the more liquid at room temp. Monounsaturated Fatty Acid Usually of Plant origin Liquid at Room Temp Can Become saturated if a chemical change occurs Foods: Peanuts, Peanut oil, Olives & Olive oil, Almonds, Pecans, Canola oil Polyunsaturated Fatty Acids Plant Origin Liquid at Room Temp. Foods: Vegetable Oils, Sunflower oils, some margarines, french dressing, walnuts Trans-Fatty Acids Not currently mentioned on food labels Carry a risk similar to saturated fats Elevated blood cholesterol & thus raise the risk of heart disease & heart attack Blood Lipid Profile Triglycerides: <100 mg/dl desired Cholesterol: <200mg/dl 200-239 Borderline CVD. > 240 ^ risk Lipoproteins: HDL – High density – good 29-77 mg/dl Carry cholesterol away from cell LDL Low density – bad 62-185 mg/dl Carry cholesterol to cell Cholesterol – Food Sources Egg Yolk Organ meats (especially liver & kidney) Cream Butter Ice Cream Cheese What about Fat Substitutes? “O’lean”, Olestra O’lestra: is indigestible therefore the body has no way to take it apart Problems: causes digestive distress & nutrient losses i.e.: gas, diarrhea, cramping, strong “urge to go” Oil can leak thru feces & leak from the anus May interfere with absorption of fat soluble vitamins Proteins – The Most Expensive Nutrient Building blocks are amino acids Structural part of every cell Four major functions of protein in the body Maintenance of Growth Regulation of Body Process Development of Immunity Energy Amino Acids Essential: (9) Means they cannot be manufactured by body & must be obtained from food Nonessential: Can be synthesized by body Often derived from other amino acids Complete vs Incomplete Protein Foods Complete: Have all 9 Essential Amino Acids Examples: Meat, Eggs, & Milk Incomplete: Lack some Amino Acids Some foods mixed together = a complete protein food Dietary Fiber 20-35 g/day Soluble: Able to dissolve in H2O Beans, oatmeal, barley, broccoli, citrus fruits Regulate blood glucose level Dietary Fiber Insoluble: Incapable of being dissolved Fruits and vegetable skins, nuts, popcorn Promote bowel regularity Water – H20 Must be consumed often & in greater quantities Solvent in which chemical reactions occur Medium for transporting substances. Provides lubrication Contributes turgor to cells Regulates body temperature Micronutrients - Vitamins Fat Soluble: A, D, E, K Stored in the body Stable in heat No nitrogen Require bile for absorption Soluble in fats Water Soluble: C, B Complex Soluble in water May be affected by cooking methods B Complex contains Nitrogen Very little stored therefore few toxic levels occur Minerals Minerals, or elements: are inorganic substances Required in small amounts Cannot be synthesized in the body, must be obtained from food Some are important constituents of bones (Ca), others are required to activate specific enzymes involved in chemical reactions, to maintain acid-base balance (Mg, P, Na, Cl) & water balance (K, Cl) & muscle functions (Mg, K, Na, Ca). Approx. 3-6% of the body weight is made up of minerals (ash). Minerals should be supplied daily because they are excreted every day by the kidneys, bowel, & skin. Minerals are stored! Minerals (con’t) Minerals are found in organic compounds or inorganic compounds & as free ions. Consider the following when assessing Nutritional Status 1. Anthropometric measurements: Ht, Wt, Skin folds, Arm Circumference 2. Dietary History 3. Clinical signs of poor nutrition 4. Energy Level 5. Factors Affecting Religious Considerations Jewish: Don’t mix meat & dairy products at the same meal Prohibited Foods: All products obtained from pigs: i.e.: pork, bacon, ham, animal shortening, marshmallows (gelatin) Religious Considerations (con’t) Catholic: Seven-Day Adventist: Prohibited Foods: Pork products & shellfish Alcoholic beverages Church of Jesus Christ of the Latter-Day Saints (Morman): Abstain from eating meat & from eating between meals on Ash Wednesday & Good Friday Observe periods of fasting Alcoholic beverages Christian: Alcoholic beverages Nursing Interventions to Encourage Nutrient Intake Assess situation: Foods, History, Health Issues, etc. Provide Foods they like Consult with Registered Dietician Environmental Changes Consider Medical Treatment: Meds around meals Food Pyramid Guide MILK Products: 23 *Serving is 1 cup (8oz) FRUIT: 2-4 VEGETABLES: 3-5 BREADS & CEREALS: 6-11 MEAT/FISH: 2-3 * Serving is 2-3 oz. Factors to Consider When Planning a Meal Include all of the food groups Use variety: Color, Texture, Flavor, Shape, Satiety, Sociologic & personal preference Time & Energy Appearance Economical fuel usage Food cost Common Therapeutic Diets Regular Liquids: Full vs Clear Soft Low Residue Low Fat Low Carbohydrate Diabetic Low sodium High fiber Calculating I & O: Do You Know Your Sources? Intake: Oral Fluids: H2O, Coke, Tea Ice chips Food (Liquid @ room temperature) Tube Feedings IV Fluids Irrigants Blood Calculating I & O: Do You Know Your Sources? (con’t) Output: Urinary Vomitus Liquid Feces Tube Drainage Wound Drainage Fistula Drainage Rapid Respirations Diaphoresis Parenteral Therapy Intake Equipment: IV Bag Drip Chamber Tubing Roller Clamp *Dial-a-Flow *Infusion Pump Ways to control Volume of Fluid to Patients IV Pumps Solusets Dial-a-Flow Setting the correct rate on the pump Counting the number of drops in the drip chamber Assessing the patient frequently Complications from IV Therapy Hematoma Phlebitis IV Care Frequent assessment Antiseptic ointment at site Changing lines per hospital protocol (q 72 hours) Insertion of a Nasogastric Tube for Suction or Feeding Have you collected ALL your supplies? What position do you need to place your patient? High Fowlers Which nostril should I use? How far do I insert the tube? Measure During insertion: What do I tell my patient. What should they be doing? What technique should I be doing? Do they stay in the same position the whole time? Bolus vs Continuous enteral feeding Measurement for NG tube The Tube is in, Now what do I do? 1. Check for placement, but how? A. Auscultation B. Aspiration C. Chest X-ray if possible. 2. Be sure they can speak. 3. Secure with tape to nose & provide comfort measures. 4. Connect to feeding or suction. pH of Secretions Yellow-Green: is pH of 1-4 = Acidic in Gastric Secretions Golden Yellow: is pH of 6.5 = Intestinal Secretions Color change toward blue: Is pH 7.0-8.0 = Lungs and a more alkaline pH Nutrition…Critical Thinking Utilize Scientific and Nursing Knowledge to interpret and analyze data. Identify nursing diagnosis and implement care. Nutrition…Nursing Process Assessment Anthropometry Body fat, body mass index, ideal body weight, height Dietary History and Health History 24 Hr recall Food patterns Culture,socioeconomi c Medications Laboratory Complete Blood Count Serum Albumin Serum iron Lymphocyte Count Physical Exam Skin, hair, nail, mucous membrane, swelling Nutrition…Nursing Process Nursing Diagnoses Aspiration, risk Breastfeeding, ineffective Constipation/Diarrhea Fluid volume deficit/excess Knowledge deficit Self-care deficit (unable to feed self) Skin integrity, altered Nutrition…Nursing Process Planning Plan optimum nutrition, improve or reduce the problem, through appropriate nursing interventions. Nutrition…Nursing Process Implementation Health Promotion Teaching proper diet, good nutrition habits Food preparation Feeding Patients with Dysphagia Diets Clear,full, pureed, mechanical soft, soft, regular Enteral Feeding Insertion Site Care Patency/Flushing with water Check for placement Trouble shooting Feedings – Formula Nutrition…Nursing Process Implementation-2 Enteral Feeding Bolus or Intermittent Feeding Continuous Feeding bag and IV pole; infusion pump Parenteral Nutrition – lipids, glucose, amino acids, vitamins, minerals Gradual increase and gradual reduction to stop Complications-air embolus, infection, abnormal levels Nutrition…Nursing Process Implement/Medical Nutrition Gastrointestinal Disorders Peptic ulcer – no caffeine, spicy foods Crohn’s –fiber, vitamin, iron supplements Celiac-gluten free diet Diverticulitis –low residue Diabetes Mellitus –complex carbohydrates Cardiovascular-fat, sodium, cholesterol, K+ Pulmonary-fluids, macronutrients Nutrition…Medical Therapy (contd) Renal – chronic – fluid, sodium, K+, protein, phosphate. Cancer –diet to meet nutritional deficits cause by treatment. HIV – individualized based on nutritional needs. Nutrition…Nursing Process Evaluation Incorporate dietary changes into his lifestyle with least amount of stress or disruption to client and ensure outcomes are met. Increase diet knowledge, promote optimum nutrition. Nutrition…Summary Nutrition – basic human needs. Knowledgeable about elements of nutrition. Utilize knowledge in meeting nutritional needs/diets for optimum nutrition.