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  1. 1. Nutrition and Diet Therapy 8th Edition by Ruth Roth and Carolynn Townsend
  2. 2. Nutrition and Diet Therapy PowerPoint  Presentation Written by Susan L. Robson, MSN, RNP-c
  3. 3. Section 1 <ul><li>Fundamentals of Nutrition </li></ul>
  4. 4. Chapter 1 <ul><li>The Relationship of Food and Health </li></ul>
  5. 5. Objectives <ul><li>Name the six classes of nutrients and their primary functions </li></ul><ul><li>Recognize common characteristics of well-nourished people </li></ul><ul><li>Recognize symptoms of malnutrition </li></ul>
  6. 6. Objectives <ul><li>Describe ways in which food and health are related </li></ul><ul><li>List the four basic steps in nutrition assessment </li></ul>
  7. 7. Nutrients <ul><li>Chemical substances necessary for life </li></ul><ul><li>Functions </li></ul><ul><ul><li>Provide energy </li></ul></ul><ul><ul><li>Build and repair tissue </li></ul></ul><ul><ul><li>Regulate body processes </li></ul></ul>
  8. 8. Nutrients <ul><li>Six classes </li></ul><ul><ul><li>Carbohydrates </li></ul></ul><ul><ul><li>Fats (lipids) </li></ul></ul><ul><ul><li>Proteins </li></ul></ul><ul><ul><li>Vitamins </li></ul></ul><ul><ul><li>Minerals </li></ul></ul><ul><ul><li>Water </li></ul></ul>
  9. 9. Nutrients <ul><li>Organic </li></ul><ul><ul><li>Contains carbon, hydrogen, oxygen </li></ul></ul><ul><ul><li>Carbon is found in all living things </li></ul></ul><ul><ul><li>Example: carbohydrates, fats, proteins, vitamins </li></ul></ul><ul><li>Inorganic </li></ul><ul><ul><li>In simplest form when ingested </li></ul></ul><ul><ul><li>Function: regulate body processes </li></ul></ul><ul><ul><li>Example: water, minerals </li></ul></ul>
  10. 10. Carbohydrates <ul><li>Provides major source of energy </li></ul><ul><li>Examples: cereal grains, vegetables, fruits, nuts, and sugars </li></ul>
  11. 11. Fats (lipids) <ul><li>Provides energy </li></ul><ul><li>Highest kilocalorie value </li></ul><ul><li>Sources of fat: meats, milk, cream, butter, cheese, egg yolks, oils, nuts </li></ul>
  12. 12. Protein <ul><li>Builds and repairs body tissues </li></ul><ul><li>Provides energy </li></ul><ul><li>Only one of the six nutrients that contains nitrogen </li></ul><ul><li>Sources of protein: meats, fish, poultry, eggs, milk, cheese, corn, grains, nuts, and seeds </li></ul>
  13. 13. Vitamins <ul><li>Organic compounds </li></ul><ul><li>Regulate body processes </li></ul><ul><li>Examples: vitamins A, B, C, D, E and K </li></ul>
  14. 14. Minerals <ul><li>Inorganic compounds </li></ul><ul><li>Regulate body processes </li></ul><ul><li>Examples: calcium, phosphorus, potassium, sodium, chloride, iron, magnesium, zinc </li></ul>
  15. 15. Water <ul><li>Major constituent of all living cells </li></ul><ul><li>Composed of hydrogen and oxygen </li></ul>
  16. 16. The Six Essential Nutrients and Their Functions Regulates body processes Water Regulate body processes Minerals Function Inorganic Nutrients Regulate body processes Vitamins Build & repair tissues Proteins Provide energy Fats Provide energy Carbohydrates Function Organic Nutrients
  17. 17. Stop and Share <ul><li>A client is at home recovering from surgery. You ask the client what they have eaten over the past 24 hours. The client states the following: </li></ul><ul><ul><li>Breakfast: 2 doughnuts, orange juice </li></ul></ul><ul><ul><li>Lunch: lettuce salad with oil & vinegar, soda </li></ul></ul><ul><ul><li>Snack: pretzels, soda </li></ul></ul><ul><ul><li>Dinner: spaghetti with tomato sauce, garlic bread; wine </li></ul></ul>
  18. 18. Stop and Share <ul><li>Discuss the answers to the following questions: </li></ul><ul><ul><li>What nutrients are missing in the client’s diet? </li></ul></ul><ul><ul><li>Why are these nutrients important for this client? </li></ul></ul>
  19. 19. Stop and Share <ul><li>The client is missing protein and water in the diet. </li></ul><ul><li>Protein is needed to build and repair body tissues after surgery. </li></ul><ul><li>Water is needed to prevent dehydration. </li></ul>
  20. 20. Characteristics of Nutritional Status Poor color Good color Greasy, blemished complexion Clear complexion Dull, lifeless hair Shiny hair Apathy Alert expression Poor Good
  21. 21. Characteristics of Nutritional Status Underdeveloped, flabby muscles Firm, well-developed muscles Swollen abdomen Firm abdomen Red, puffy, receding gums, and missing or cavity-prone teeth Pink, firm gums and well-developed teeth Dull, red-rimmed eyes Bright, clear eyes Poor Good
  22. 22. Characteristics of Nutritional Status Easily irritated, depressed, poor attention span Emotional stability Slumped posture Erect posture Over- or underweight Normal weight for height Bowed legs, “pigeon breast” Well-developed bone structure Poor Good
  23. 23. Characteristics of Nutritional Status Constipation or diarrhea Normal elimination Insomnia at night, fatigued during the day Healthy, normal sleep habits Excessive or poor appetite Healthy appetite Frequently ill Seldom ill Easily fatigued Good stamina Poor Good
  24. 24. Stop and Share <ul><li>Divide into groups of 2. </li></ul><ul><li>Assess your partner for signs of good nutrition. </li></ul><ul><li>Identify common characteristics associated with good nutrition exhibited in your partner. </li></ul>
  25. 25. Stop and Share <ul><li>Shiny hair </li></ul><ul><li>Clear skin </li></ul><ul><li>Clear eyes </li></ul><ul><li>Erect posture </li></ul><ul><li>Alert expressions </li></ul><ul><li>Firm flesh on well-developed bone structures </li></ul><ul><li>Pink gums and well-developed teeth </li></ul><ul><li>Normal weight for height </li></ul>
  26. 26. Malnutrition <ul><li>Overnutrition </li></ul><ul><ul><li>Excess energy or nutrient intake </li></ul></ul><ul><li>Undernutrition </li></ul><ul><ul><li>Deficient energy or nutrient intake </li></ul></ul><ul><li>Overnutrition is a larger problem in the United States than undernutrition. </li></ul>
  27. 27. Stop and Share <ul><li>Identify at least 5 signs of malnutrition present in this child. </li></ul>Courtesy of the Centers for Disease Control and Prevention, Public Health Image Library
  28. 28. Stop and Share <ul><li>Poor quality hair </li></ul><ul><li>Mottled complexion </li></ul><ul><li>Dull expression </li></ul><ul><li>Spindly arms and legs </li></ul><ul><li>Bloated abdomen </li></ul>
  29. 29. Relation of Food to Health <ul><li>Cumulative </li></ul><ul><ul><li>Excess nutrients over time </li></ul></ul><ul><ul><li>Examples: atherosclerosis, obesity, hypertension, diabetes, gallbladder disease, some cancers </li></ul></ul><ul><li>Deficiencies </li></ul><ul><ul><li>Nutrients lacking for extended period </li></ul></ul><ul><ul><li>Examples: iron deficiency, beriberi, scurvy, osteomalacia, osteoporosis, rickets, goiter </li></ul></ul>
  30. 30. Deficiency Diseases <ul><li>Deficiency Disease </li></ul><ul><li>Iron deficiency </li></ul><ul><li>Iron-deficiency anemia </li></ul><ul><li>Beriberi </li></ul><ul><li>Night blindness </li></ul><ul><li>Goiter </li></ul><ul><li>Kwashiorkor </li></ul><ul><li>Marasmus </li></ul><ul><li>Nutrients Lacking </li></ul><ul><li>Iron </li></ul><ul><li>Iron </li></ul><ul><li>Thiamin </li></ul><ul><li>Vitamin A </li></ul><ul><li>Iodine </li></ul><ul><li>Protein </li></ul><ul><li>All nutrients </li></ul>
  31. 31. Deficiency Diseases Calcium and vitamin D Osteoporosis Calcium, vitamin D, phosphorus, magnesium, and fluoride Osteomalacia Nutrients Lacking Deficiency Disease
  32. 32. Deficiency Diseases <ul><li>Deficiency Disease </li></ul><ul><li>Pellagra </li></ul><ul><li>Rickets </li></ul><ul><li>Scurvy </li></ul><ul><li>Xerophthalmia </li></ul><ul><li>(blindness) </li></ul><ul><li>Nutrients Lacking </li></ul><ul><li>Niacin </li></ul><ul><li>Calcium and vitamin D </li></ul><ul><li>Vitamin C </li></ul><ul><li>Vitamin A </li></ul>
  33. 33. Nutritional Assessment <ul><li>Anthropometric measurements </li></ul><ul><li>Clinical examination </li></ul><ul><li>Biochemical tests </li></ul><ul><li>Dietary/social history </li></ul>
  34. 34. Anthropometric Measurements <ul><li>Height </li></ul><ul><li>Weight </li></ul><ul><li>Head circumference (children) </li></ul><ul><li>Upper arm measurement </li></ul><ul><li>Skinfold </li></ul>
  35. 35. Anthropometric Measurements Height Weight
  36. 36. Anthropometric Measurements Head circumference Triceps skinfold
  37. 37. Clinical Examination Possible Deficiencies Clinical Signs Folic acid Glossitis Riboflavin Lesions at corner of mouth Vitamin A Bumpy “gooseflesh” Protein Edema Iron, copper, zinc, B12, B6, biotin Pallor, blue half circles beneath eyes
  38. 38. Clinical Examination Carbohydrates, proteins; kcal Emaciation Vitamin C Numerous “black and blue” spots and tiny, red “pin prick” hemorrhages under the skin Possible Deficiencies Clinical Signs
  39. 39. Clinical Examination Vitamin K Slow clotting time of blood Vitamin C Poorly shaped bones or teeth or delayed appearance of teeth in children Possible Deficiencies Clinical Signs
  40. 40. Clinical Examination Fat Eczema Iodine Goiter Calcium, potassium, sodium Tetany Niacin Unusual nervousness, dermatitis, diarrhea in same patient Possible Deficiencies Clinical Signs
  41. 41. Biochemical Tests <ul><li>Serum albumin level </li></ul><ul><ul><li>Measures main protein in blood </li></ul></ul><ul><ul><li>Determines protein status </li></ul></ul><ul><li>Serum transferrin level </li></ul><ul><ul><li>Indicates iron-carrying protein in blood </li></ul></ul><ul><ul><li> indicates iron stores low </li></ul></ul><ul><ul><li> indicates body lacks protein </li></ul></ul>
  42. 42. Biochemical Tests <ul><li>Blood urea nitrogen (BUN) </li></ul><ul><ul><li>may indicate renal failure, insufficient renal blood supply, or blockage of the urinary tract </li></ul></ul><ul><ul><li>Serum creatinine </li></ul></ul><ul><ul><li>indicates amount of creatinine in blood </li></ul></ul><ul><ul><li>used to evaluate renal function </li></ul></ul>
  43. 43. Biochemical Tests <ul><li>Creatinine excretion </li></ul><ul><ul><li>indicates amount of creatinine excreted in urine over a 24-hour period </li></ul></ul><ul><ul><li>used in estimating body muscle mass </li></ul></ul><ul><ul><li>muscle mass depleted, as in malnutrition; level will be low </li></ul></ul>
  44. 44. Biochemical Tests <ul><li>Other tests </li></ul><ul><ul><li>Hemoglobin (Hgb) </li></ul></ul><ul><ul><li>Hematocrit (Hct) </li></ul></ul><ul><ul><li>Red blood cells (RBCs) </li></ul></ul><ul><ul><li>White blood cells (WBCs) </li></ul></ul><ul><ul><li>Lipid profile (high & low-density lipoprotein, serum triglycerides) </li></ul></ul><ul><ul><li>Urinalysis </li></ul></ul>
  45. 45. Dietary/Social History <ul><li>Evaluation of food habits. </li></ul><ul><ul><li>24-hour recall: Client interviewed by the dietitian and asked to give types, amounts, and preparation of all foods eaten in past 24 hours </li></ul></ul><ul><ul><li>Food diary: written record of all food and drink ingested in a specified period </li></ul></ul><ul><ul><li>Computer diet analysis to determine nutrient deficiencies or toxicities </li></ul></ul>
  46. 46. Dietary/Social History <ul><li>Social history </li></ul><ul><ul><li>Consideration of financial resources to obtain needed food, and properly store and cook food </li></ul></ul><ul><ul><li>Food-drug interactions that can lead to malnutrition </li></ul></ul>
  47. 47. Conclusion <ul><li>Nutrition and health are directly related. </li></ul><ul><li>Effects of poor nutrition are cumulative. </li></ul><ul><li>There are six essential nutrients: carbohydrates, fats, proteins, minerals, vitamins, and water. </li></ul><ul><li>Nutritional assessment is the best way to determine deficiencies that may result from lack of nutrients. </li></ul>