Transcript Nutrition Concept.Finalx

NUTRITION
Heather Rawls RN MS
Goals for This Concept Presentation
1. Define and describe the concept.
2. Notice risk factors that place
individuals at risk for nutrition
problems.
3. Recognize when an individual is
experiencing inadequate nutrition.
4. Provide appropriate nursing and
collaborative interventions to
optimize nutrition.
Define and Describe the Concept of
nutrition
Definition
Nutrition is the science of optimal cellular metabolism and its
impact on health and disease
Nutrition- the process by which the body ingests, absorbs,
transports uses and eliminates nutrients and foods .
Key Terms
Discuss the meaning of the following terms:
– Macronutrients
– Micronutrients
– Kilocalorie
– Malnutrition
– Hypoalbuminemia
How do the terms relate to the concept of
nutrition?
Scope and Categories of Nutrition
Problems
• Excessive or
Insufficient quantity of
• Macronutrients
• Micronutrients
Health status and nutrition are integral to one another—that is, poor
nutritional status negatively impacts health, and poor health status can
negatively impact nutritional status.
• Insufficient quantity of
• Macronutrients
• Micronutrients
• Sufficient quantity of
• Macronutrients
• Micronutrients
CONCEPT ----------NUTRITION
Cognition
Thermoregulation
Attributes
Adequate Intake for:
Development-Energy- GrowthTissue Repair
Ideal Ht-Wt-BMI—(MAC) (MAMM)
Muscle Tone-Strength-Agility-Reflex
Response
Cognitive & Mood Response.
Albumin WNL
Hemoglobin & Hematocrit WNL
Electrolytes WNL
Nursing Care
Patient Education
Metabolis
m
Interrelated
Concepts
Clotting
Fluid and Electrolytes
Diversity-(Lifestyle-Culture)
Human Development
Antecedents
Normal Alimentary Tract
and Associated Organs
Adequate Ingestion of
Nutrients and Water
Normal Temperature
Normal ph
Medical
Conditions
Nutrition
The process by which
the body ingests,
absorbs, transports
uses and eliminates
nutrients and foods
(NC)
Consequences
(Outcomes)
Negative
Malnutrition
Insufficient/Excess Intake
Failure to thrive--Obesity
Malnutrition
Physiological-Psychological- Dysfunction
Ingestion- Digestion-Absorption-Metabolism
Risk factors
Physiological &
Psychological
Development
Medications
Age-Gender-Genetics
Sub Concepts
Ethnicity
Socioeconomics
Knowledge
Lifestyle Behaviors
Diets
Growth &
Tissue
Repair
Positive
Homeostasis/Adequate
Nutrition Hydration
Nutrients
Food Allergies
Physiological and
Psychological
Wellness
Engage in Physical Activity
Altered Hydration Status
Low energy-Fatigue
Depression-Isolation
Growth/ Developmental Delay
Decreased Bone Density
Delayed-Inadequate Healing
Illness-Muscle wasting-Death
Components of Concept Analysis
Diagram
Attributes -- Characteristics
 Adequate intake
 Ideal height, weight,
BMI
 Presence of adequate
muscle tone, strength,
agility
 Appropriate cognition
and mood response
 Albumin, Electrolytes
and Hbg, Hct, within
defined limits
Antecedents – What comes
before
 Normal alimentary
track and associated
organs
 Adequate intake of
nutrients and water
 Normal temperature
 Normal pH
Components of Concept Analysis
Diagram Continued
Interrelated Concepts
Sub-Concepts
 Thermoregulation
 Age, Gender, Genetics
 Metabolism
 Risk factors
 Cognition
 Clotting
 Fluid and Electrolytes
 Immunity
 Lifestyle and Culture
 Developmental
 Ethnicity, Socioeconomics
 Lifestyle behaviors
 Medications
 Medical conditions
 Food allergies
 Physiological/Psychologica
l development
Consequences
Positive Consequences
Negative Consequences
 Homeostasis, adequate
 Malnutrition – obesity
nutrition and hydration
 Physiological/Psychologica
l wellness
 Growth and tissue repair
 Ability to engage in
physical activity
 Malnutrition – failure to thrive
 Low energy, fatigue
 Depression
 Growth and development delay
 Decreased bone density
 Delayed or inadequate healing
 Illness, muscle wasting, death
Review of Anatomy and Physiology
Protein
 Our overall physical health and
well-being depend on our
eating enough essential amino
acids for body protein
synthesis.
 Proteins are organic
compounds formed by the
linking of many smaller
molecules of amino acids,
amino acids contain nitrogen,
which distinguish protein
from other nutrients.
 Functions
 Growth and maintenance
 needed to make the proteins
required to support muscle,
tissue, bone formation, and the
cells themselves
 Creation of communicators and
catalysts
 vital substances produced by our
bodies are formed of protein
 Ex. Insulin




Immune system response
Fluid and electrolyte regulation
Acid-base balance
Transportation
Carbohydrates (CHO)
 CHO we consume are
primarily form plant sources.
 Energy is the only real
nutrient function of CHO
 When adequate amounts of
CHO ae available, both Cho
and small amounts of fats are
used for energy.
 food sources include the following:
 Grains: Cereals, breads, crackers, rice,




or pasta, at least half as whole grains
(see following chart)
Vegetables: Fiber-rich vegetables, starchy
vegetables such as carrots, sweet
potatoes, white potatoes, peas; legumes
or dry beans such as kidney beans,
chickpeas, and black-eyed peas
Fruits: Fiber-rich fruits, most fruits
especially bananas, grapes, pears, apples
Milk: Fat-free or low fat milk, yogurt,
and other milk products containing
lactose (does not include most cheeses)
Meats and beans: Replace animal sources
with servings of legumes or dry beans
Fats

refers to the chemical group
called lipids.
 Lipids are divided into three
classifications: fats (or triglycerides),
and the fat-related substances of
phospholipids and sterols.
 Approximately 95% of the lipids in
foods and in our bodies are in the
triglyceride form of fat.
 The other two lipid classifications are
the fat-related substances of
phospholipids and sterols.
 Lecithin is the best-known phospholipid
 Cholesterol is the best-known sterol.
 Function
 Source of Energy
 Palatability
 Fat makes food smell and taste
good
 Satiety and Satiation
 helps prevent hunger between
meals
 Food Processing
 Nutrient Source
 Stored Energy
 Organ Protection
 Insulation
Essential fatty acid deficiency
 A, pt receiving fat-free parenteral nutrition has
developed biochemical abnormalities and skin lesions as
shown here.
 B, Resolution in same patient after 2 weeks of tx.
Vitamins
 Functions
 Food Sources
 Blood Health
 In almost all foods, yet no
 Bone Health
one food group is a good
source of all vitamins.
 It is always best to
consume vitamins from
food sources
 Fresh fruits and vegetables
are particularly rich
sources.
 Fluid and Electrolyte
Balance
Minerals
 prime sources of minerals include both plant and animal
foods.
 Valuable sources of plant foods include most fruits, vegetables,
legumes, and whole grains.
 Animal sources consist of beef, chicken, eggs, fish, and milk
products.
Fiber
 All the health benefits of fiber improve the physical
functioning of the human body. The benefits are not directly
nutritional but instead allow the body to function at a more
efficient level.
 consists of substances in plant foods that, for the most part,
cannot be digested by humans.We do not produce digestive
juices strong enough to break down the bonds that hold the
simple carbohydrates of most plant fibers, so fiber “passes
through” our bodies without providing kcal or nutrients. Its
texture provides bulk and eases the work of the GI muscles
that regulate movement of the food mass
Water
 We can live several weeks
without food but can survive
only a few days without water
or fluids.
 Although our bodies use
stored nutrients to fuel
energy needs, a minimum
intake of water is required for
cell function and as a solution
through which waste
products of the body are
excreted in urine.
 The Adequate Intake (AI)
recommendations for
water are about 13 cups a
day for men and 9 cups a
day for women. This
amount is in addition to
fluids from foods
consumed throughout the
day, such as fruits and
vegetables. Although the
minimum amount needed
by healthy adults may be
about 4 cups, higher
amounts are optimum
considering an individual's
physiologic status and
energy output.
Consequences: Malnutrition
 Each macronutrient and micronutrient has specific functions
 Protein
 Carbohydrate
 Fatty acids
 Vitamins
 Minerals
 Fiber*
 Water*
 Effects of deficiency or excess relate to the functions
* not Macro or Micro nutrients, but important to discuss.
Deficiencies and Excess Intake
Identify the function of each macronutrient listed and the consequences of its
deficiency and excess intake.
Macro- nutrient
Protein
Carbohydrate
Fatty acids
Physiologic
Function
Effects of
Deficiency
Effects of Excess
Intake
Notice Risk factors that place
individuals at risk for Nutrition
problems
Risk Factors:
Populations at Greatest Risk
 All individuals are potentially at risk
 Socioeconomic status and race or ethnicity can
influence risk
 Populations at greatest risk for problems with nutrition
are
 Very young children
 Elderly adults
Individual Risk Factors
Collaborative Learning
Discuss how the following risk factors link to nutrition problems.
Risk Factor
Genetics
Lifestyle
Inconsistent eating patterns
Conditions that affect oral intake
Conditions associated with impaired
digestion
Conditions associated with impaired
metabolism
Link to Nutrition Problem
Recognize when an individual has
problems with Nutrition
Recognizing Optimal Nutrition
Discuss general clinical findings you would expect to see in a wellnourished individual across the lifespan.
Age-Group
Infants and children
Adolescents
Adults
Older adults
Expected Clinical Findings
Common Diagnostic Tests
 Laboratory tests
 Albumin; blood glucose; hemoglobin A1C; lipid
profile; electrolytes; blood urea nitrogen
(BUN); tests to rule out anemia; calcium,
phosphorus, and vitamin D levels
 Radiographic scans
 DXA scans (done density)
Provide appropriate nursing and
collaborative interventions to optimize
Nutrition
Clinical Management: Primary Prevention

Healthy diet
 2015 Dietary Guidelines for Americans
 ChooseMyPlate http://www.choosemyplate.gov/

Physical activity
 Physical exercise for 30 minutes most days of the week
 "On average, the U.S. diet is low in vegetables, fruit
and whole grains and too high in calories, saturated
fat, sodium, refined grains and added sugars,“
 Americans eat too little vitamin D, calcium, potassium
and fiber and eat way too much fat and salt.
 “About half of all Americans—117 million individuals
— have one or more preventable chronic diseases that
relate to poor dietary patterns and physical inactivity,
including cardiovascular disease, hypertension, type 2
diabetes and diet-related cancers,
 "More than two-thirds of adults and nearly one-third
of children and youth are overweight or obese."
http://www.nbcnews.com/health/health-news/newdiet-proposals-eat-your-veggies-have-some-coffeen309026
Clinical Management: Screening
Screening at Birth
Screening During
Pregnancy
Genetically linked
metabolic disorders
Glucose
Screening for Adults
Lipids
Anemia
Body mass index
Gestational diabetes
HgbA1C
 General Discussion Questions
 What are examples of genetically linked metabolic disorders for which
screening is done at birth?
 At what age should adults start having lipid screens?
 How often should lipid screening be done?
 What factors inhibit lipid screening from being done?
 At what time in the pregnancy is the mother checked for gestational
diabetes?
 What is a HgA1C?
BMI
<19
Underweight; severe level <15 indicative of anorexia
19-24.9
Optimal body weight composition. Elderly persons should strive
for BMI >21
25-29.9
Overweight; may be appropriate given health status
30-34.9
Class I obesity; slow weight loss advised to promote permanent
weight loss
Not appropriate for elder population to lose weight
35-39.9
Class II obesity; slow weight loss advised
May be a candidate for bariatric surgery if comorbidities present
and not able to achieve long-term weight loss through diet and
exercise
≥40
Class III or “extreme” obesity (formerly known as morbid obesity)
May be a candidate for bariatric surgery based on health status,
age, and level of obesity and history of not being able to achieve
long-term weight loss through diet and exercise
Clinical Management: Collaborative
Interventions
 Treatment strategies depend on the
underlying condition
 The most common strategies include
 Dietary interventions
 Pharmacotherapy
 Surgery
Dietary Interventions
 Medical nutrition therapy
 provided by registered dietitians (RDs)
 Basic therapeutic diets
 No Added Salt diet (3 to 4 g of Na+)
 2 g of Na+ diet
 Consistent or Controlled Carbohydrate diet (Diabetic diet)
 Renal diet typically implies restrictions in phosphorus, sodium, and
potassium. (low protein)
 Dietary Supplements
 Oral supplements
 Ready to use formulas (powdered form or liquid form)
 Specific types based on nutrient source, essential nutrients is specified
volume, elmental formulas, and disease specific formulas.
Surgical Interventions
 Bariatric surgery
 Nonmalabsorptive procedures
 Malabsorptive procedures
 Common complications
 Surgical complications
 Nutrient deficiencies
Pharmacologic Agents
 Weight loss medications
 Antilipid agents
 Micronutrient supplements
 Parenteral nutrition
Quick Quiz!
1. A 22-year-old new mother is breastfeeding.You ask her if she is
taking the correct quantities of nutrients.Which statement reflects
that she understands the dietary guidelines?
A. “I am not concerned with what I am eating.”
B. “I am taking vitamin doses based on TV.”
C. “I am taking a daily MVI.”
D. “I am making eating choices according to the recommended
dietary allowances and intakes.”
Interrelated Concepts
General Discussion
Question
Why does the figure show
overlapping of the concepts of
glucose regulation and nutrition?
Ans: dependent on caloric
intake and is critical to
adequate metabolism of
nutrients; in fact, glucose
regulation can also be
considered a subconcept of
nutrition. For this reason, an
overlap exists between these
two concepts
Reference
 Giddens, J.F. (2012) Concepts for Nursing Practice. St. Louis:
Elsevier.