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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
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Nutrition
Nutrition is interaction between anorganism and the food it consumes
Food & eating is a basic need, affects
health Various factors affect nutrition
Nutrientssubstances used by the
body for growth & development Role of nurse to teach, guide and
inform on the importance of
proper nutrition
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Nursing Assessment
Dietary intake and food preparation
Unpleasant symptoms
Allergies
Taste, chewing and swallowing
Appetite and weight Use of medications
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Nutritional health-care Team
MD
Nurse
Social Worker
Physical Therapist
Occupational Therapist Speech Pathologist
Pharmacist
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Essential Nutrients Regulatory Nutrients
Water
Carbohydrates Proteins
Lipids
Vitamins
Minerals
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Water
Water: present in every cell
Absorbedin small /large intestine
Metabolizedcarbohydrates, proteins,lipids produce water
Dietary intake from fluids and solid
food provide water
Function: fluid medium needed for all
chemical reactions in the body
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Carbohydrates
Carbohydrates: simple or complex Digestedby enzymes
(amylase/lactase)
Absorbedin small intestine
Metabolizedinto glucose which is
used for energy or storedStored as
either glycogen or fat
Function: provide energy, spare
proteins
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Carbohydrates (CHO)
CarbonHydrogen-Oxygen
1 gram carbohydrate = 4 Kcal
Monosaccharidessimple sugars
glucose, fructose, galactose Dissaccharidesdouble sugars
sucrose, lactose, maltose
Polysaccharidescomplex forms
starch, glycogen, cellulose (fiber)
Recommended intake: 60% of total Kcal (300g)Fiber 25-30g daily
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Carbohydrates
What are some other functions of
carbohydrates in our bodies?
Laxative effects of:
Lactose
Cellulose
DIETARY FIBER -
Helps regulate blood
sugar
May reduce risk ofhyperlipidemia
May reduce risk of some
cancers
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Protein
Proteins: composed of amino acids Digestedby enzymes (proteolytic)
Absorbedin small intestine
Metabolismincludes:
Anabolism=Catabolism: Nitrogen
balance Function: maintain body
tissue and tissue growth
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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 acidsbody 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 whencombined provide all essential amino acids.
Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)
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Lipids
Lipids: insoluble in water Digestedby enzymes (lipase,bile) in
stomach and small intestine
Absorbedin small intestine Metabolismincludes conversion (by
liver and small intestine) into soluble
compounds called lipoproteins Function: energy, insulates body,
absorption (fat-soluble vitamins)
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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
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Lipids
Lipoproteins- made by the body to move water-insoluble lipids (such as cholesterol)thru the
bloodstream
LDL(low density lipoprotein)- major carrier of
cholesterol. Function is to transport cholesterolfrom liver into circulation. Bad cholesterol
HDL(High density lipoprotein) - carries
cholesterol away from tissue to liver ..high levelsdecrease atherosclerosis. Good cholesterol
Cholesterol- not essential from diet as the body
produces enough.
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Desirable Blood Lipid Levels
Total Cholesterol < 200
Triglycerides < 150
LDL < 100 HDL > 40 Male
> 50 Female
Elevated Blood Lipid Levels(Hyperlipidemia) = increased risk for CHD,Hypertension, Stroke, MI
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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
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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
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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
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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
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Folic Acid
Folic Acid (Folate)
Folic Acid Deficiency leads to elevated Homocysteinelevels which are associated with increased risk for CHD.
Folic Acid Deficiency linked to neural tube defectsSpina Bifida
Natural folate (in foods) only as available to body as
supplement folic acid 1998 = mandatory fortification of breads/grains
Supplements recommended for: women of child-bearingage, gastric surgery, malabsorption (alcholic)
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Fat-soluble Vitamins text review Vitamin A: function- visual acuity, skin
maintenancedeficiency-night blindnessDark green leafy vegs, yellow/orange vegs
Vitamin D: function-calcium absorption deficiency-rickets, bone malformation
Fortified milk, ultraviolet light Vitamin E: function-antioxidant, heme
synthesisdeficiency-RBC hemolysis
Whole grains, nuts
Vitamin K: function-formation blood clottingproteinsdeficiency- hemorrhage
Dark green leafy vegs, synthesized by bacteria in smintestine
More prone to toxicity; stored by body
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Minerals
Minerals: macrominerals or microminerals
Originate in earths crust, arent digested or
metabolized. Combine to form salts or organiccompounds. Always retain their chemical
properties.
Function: provide structure within the body(bones/teeth, F/E and acid /base balance, nerve
transmission, muscle contraction)
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Macrominerals text review Calcium: bone/ teeth formation, blood clotting,
nerve transmissiondeficiency-tetany,
osteoporosis
Phosphorous: bones, acid-base
balancedeficiency- muscle weakness
Magnesium:bones, metabolism ...deficiency-
muscle pain, poor cardiac function Potassium: f/e balance, acid-base balance
deficiency-muscle cramps , irregular ht. rate
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Energy Balance
Kilocalorie- unit of heat; measures theenergy in the diet
Basal metabolic rate (BMR)- amountof energy needed for all the
biochemical processes to occur when
the body is at rest. Proper nutrition provides the energy
needed to maintain health
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Body Weight Standards
Ideal bodyweight IBW =
balance ofenergy usedby the bodyand intake of
nutrients
Rule of thumbWomen: 100 lbs lst 5ft
5 lbs/inch over 5ftMen: 106 lbs lst 5 ft
6 lbs/inch over 5ft
Standardized chartsOverweight = 10% > chartObese = 20% > chart
Body mass index(BMI)18.524.9 healthy> 25 = overweight> 30 = obese> 40 = morbidly obese
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Calculate your BMI
Weight (lbs)
Height (inches) squared
X 705
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Factors Affecting Nutrition
Developmental
Gender
Ethnicity &culture
Food beliefs
Preference
Religion
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Factors Affecting Nutrition Lifestyle
Medications &
therapy Heath status
Advertising
AlcoholConsumption
Psychological
factors
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Adequate Nutrition Food Guide
Pyramid
Daily referenceintake
Food Labeling
Dietary guidelines
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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
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Assessing: Nutrition
Nursing history
Physical exam
24-hr. recall
Food records
Anthropometic data Lab testsAlbumin & Prealbumin
HemoglobinTransferrin
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Nursing Dx
Imbalanced nutrition: less than body
requirements R/T NPO status AEB
height 56 wt 105 lbs., pt. states Ive never been this skinny before,
my clothes are hanging off of me
Impaired dentition R/T nutritionaldeficits AEB dentures not fitting
properly
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Planning- outcome criteria
Pt. will: Attain and maintain ideal body weight
Eat a variety of foods at each meal
Promote healthy nutritional practices
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Interventions
Monitoring food
intake Assist with
feeding
Stimulateappetite
Teaching
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Diet Restrictions
NPO Clear liquids-see
through (broth,apple juice)
Full liquidsfoodsthat turn to liquid atroom temp.
(shakes, milk) Softeasily chewed
and digested
Low residue- no seeds,raw vegetables orfruits, whole grains
High fiber- raw fruits,
grains, vegetables Sodium restricted:
Mild 2 gram Na/day
Moderate 1gram
Strict 500mg Severe 250 mg
DASH Dietary Approachesto Stop Hypertension
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Diet Restrictions
Calorie
restrictions
Diabetic diet
Cholesterol
Food
textures:Thick it
Thin
Nectar-like
Honey-like Spoon-thick
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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)
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Enteral Nutrition
Short term use
Nasogastric
Nasointestinal
Long term use
Gastrostomy Percutaneous
endoscopicgastrostromy(PEG)
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Enteral Formulas
Many types of formulas
Administered continuous orintermittent
Use pumps to monitor intake
Monitor Intake & Output
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Enteral Precautions
Prevent aspiration
Position fowlers/high fowlers
Assess placementcheck pH
Note residual
Auscultate bowel sounds
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Enteral Precautions
Preventing complications include:
Clogged tube Nasal erosion
Diarrhea
Infection
Dislodgement
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Parental Nutrition
Bypasses GI tract, nutritionadministered IV, more complicated
Total parental nutrition (TPN) alsocalled (hyperalimentation)centralline
Partial parental nutrition (PPN)..PICCline
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Evaluation
Use established outcomes to evaluate the
pts response to care
Pt understanding of therapeutic diet
Reassess S&S associated with altered
nutrition (wt, intake, lab results)
Determine pts satisfaction with nutritionaltherapy
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Summary
Nurses role, to understand nutrients andhow they affect nutrition
Various factors affect ones nutritionalstatus
Interventions include numerous diets,
assisting with feeding, monitoring andteaching
Nutrition can also be administered
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