This document provides an overview of basic nutrition concepts including essential nutrients, malnutrition, carbohydrates, lipids, proteins, energy metabolism, minerals, vitamins, and water. It discusses the functions and dietary sources of these nutrients. It also covers nutritional assessment, including taking a health history to identify any weight changes, appetite issues, food intolerances, medication use, medical conditions, or lifestyle factors that could impact nutrition status.

1. Lesson 2
• NUTRITION
• Basic Concepts
• Principles
• A. Essential nutrients: carbohydrates, fats, proteins,
• minerals, vitamins, and water that must be
• supplied to the body in specified amounts.
• B. Foods: the sources of nutrients, provide energy to
• help build, repair, and maintain tissue and
• regulate body processes.
• C. Malnutrition: results from deficiency, excess, or
• imbalance of required nutrients.
• Carbohydrates (Sugars and Starches)
• A. Major source of food energy; 4 kcal/g; composed of
• carbon, hydrogen, and oxygen
• B. Classification
• 1. Monosaccharides: simplest form of
• carbohydrate
• a. Glucose (dextrose): found chiefly in fruits
• and vegetables; oxidized for immediate
• energy
• b. Fructose: found in honey and fruits
• c. Galactose: not free in nature; part of milk
• sugar
• Disaccharides: double sugars

2. • a.Sucrose: found in table sugar, syrups, and
• some fruits and vegetables
• b.Lactose: found in milk
• c. Maltose: intermediate product in the
• hydrolysis of starch
• Polysaccharides: composed of many glucose
• molecules
• a. Starch: found in cereal grains, potatoes,
• root vegetables, and legumes
• b. Glycogen: synthesized and stored in the
• liver and skeletal muscles
• c. Cellulose, hemicellulose, pectins, gums,
• and mucilages: indigestible polysaccharides

3. • Dietary fiber: includes several polysaccharides
• plus other substances that are not digestible by
• GI enzymes.
• a. Dietary fiber (roughage) holds water so that
• stools are soft and bulky; increases motility
• of the small and large intestine and
• decreases transit time; reduces
• intraluminal pressure in the colon.
• b. Sources: wheat bran, unrefined cereals,
• whole wheat, raw fruits and vegetables,
• dried fruits.
• Fuctions of carbohydrates
Cheapest and most abundant source of energy;
only source of energy for central nervous system
To spare protein for tissue building when
sufficient carbohydrate is present

4. • 3.Necessary for the complete oxidation of fats
• (to prevent ketosis)
• D. Dietary sources: grains, fruits, vegetables, nuts,
• milk, sugars (“empty calories,” contain few
• nutrients)
• Lipids (Fats)
• A. Most concentrated source of energy in foods;
• 9 kcal/g; contain carbon, hydrogen, oxygen
• B. Include fats, oils, resins, waxes, and fatlike
• substances such as glycerides, phospholipids,
• sterols, and lipoproteins
• C. Fatty acids
• 1. Saturated fatty acids: usually solid at room
• temperature; predominantly present in animal
• fats
• 2. Monounsaturated fatty acids: present in oleic
• acid found in olive oil, peanut oil

5. • 3. Polyunsaturated fatty acids: usually liquid at
• room temperature; predominantly present in
• plant fats and fish
• 4. Essential fatty acids: cannot be manufactured
• by the body (e.g., linoleic fatty acid)
• 5. Nonessential fatty acids: can be synthesized by
• the body
• D. Functions of lipids
• 1. Most concentrated source of energy
• 2. Insulation and padding of body organs
• 3.Component of the cell membrane
• 4. Carrier of the fat-soluble vitamins A, D, E, K
• 5. Help maintain body temperature
• E. Dietary sources: oil from seeds of grains, nuts,
• vegetables; milk fat, butter, cream cheese; fat in
• meat; lard, bacon fat; fish oil; egg yolk

6. • F. Cholesterol: essential constituent of body
tissues
• 1. A component of cell membranes
• 2. A precursor of steroid hormones
• 3. Can be manufactured in the body
• 4. Present in animal fats
• 5. Dietary sources: egg yolk, brains, liver, butter,
• cream, cheese, shellfish
• G. Indications for low-fat diet
• 1. Cardiovascular disease
• 2. Gallbladder disease
• 3. Malabsorption syndromes, cystic
fibrosis,Pancreatitis

7. • Proteins
• A. Organic compounds that may be composed
• of hundreds of amino acids; 4 kcal/g; contain
• nitrogen in addition to carbon, hydrogen, and
• oxygen
• B. Classification
• 1. Complete protein: contains all the essential
• amino acids; usually from animal food
• sources.
• 2. Incomplete protein: lacks one or more
• essential amino acids; usually from plant food
• sources.
• C. Amino acids
• 1. Essential amino acids: eight amino acids that
• cannot be synthesized in the body and must b
• taken in food.
• 2. Nonessential amino acids: 12 amino acids that
• can be synthesized in the body.

8. • D. Functions of proteins
• 1. Necessary for growth and continuous
• replacement of cells throughout life
• 2. Play a role in the immune processes
• 3. Participate in regulating body processes such
• as fluid balance, muscle contraction, mineral
• balance, iron transport, buffer actions
• 4. Provide energy if necessary
• E. Dietary sources: meat, fish, eggs, milk, cheese,
• poultry, grains, nuts, legumes (soybeans, lentils,
• peanuts, peanut butter)
• F. Deficiencies
• 1. Conditions
• a. Kwashiorkor (protein depletion that
• develops over short period of time)

9. • b. Marasmus (severe tissue wasting from
• inadequate intake of calories and proteins)
• 2. Manifestations
• a. Generalized weakness
• b. Weight loss
• c. Lowered resistance to infection
• d. Slow wound healing and prolonged
• recovery from illness
• e. Growth failure
• f. Brain damage to fetus or infant
• g. Edema due to decreased albumin in blood
• h. Anemia in severe deficiency
• i. Fatty infiltration of liver and liver damage
• 3. Risk factors
• a. Chronically ill
• b. Elderly on fixed incomes
• c. Low-income families
• d. Strict vegetarians

10. • Indications for high-protein diet
• 1. Burns, massive wounds when tissue building
• desired
• 2. Mild to moderate liver disease for organ repair
• when liver is still functioning
• 3. Malabsorption syndromes such as cystic
• fibrosis
• 4. Undernutrition
• 5. Pregnancy to meet needs of mother and
• developing fetus
• 6. Pregnancy-induced hypertension to replace
• protein lost in urine
• 7. Nephrosis to replace protein lost in urine
• 8. Deficiencies
• Indications for low-protein diet
• 1. Liver failure (liver does not metabolize protein
• causing nitrogen toxicity to brain)
• 2. Kidney failure (kidneys can no longer excrete
• nitrogenous waste products causing toxic
• nitrogen levels in the brain)

11. • I. Nursing interventions for clients needing low-
• protein diet
• 1. Increase carbohydrates so energy needs will be
• met by carbohydrates, not by breakdown of
• proteins
• 2. Protein intake that is allowed will be complete
• proteins (animal sources)
• Energy Metabolism
• A. Measurement of energy expressed in terms of heat
• units called kilocalories (kcal): amount of heat
• required to raise 1 kg water by 1°C
• B. Energy expenditure
• 1. Basal metabolism
• a. Amount of energy expended to carry on
• the involuntary work of the body while at
• rest
• b. Factors influencing basal metabolic rate
• (BMR): body surface area, sex, age, body
• temperature, hormones, pregnancy, fasting,
• malnutrition

12. • 2. Physical activity: amount of energy expended
• depends upon the type of activity, the length
• of time involved, and the weight of the person
• C. Factors determining total energy needs
• 1. Amount necessary for BMR
• 2. Amount required for physical activity
• 3. Specific dynamic action of food ingested
• 4. Growth
• 5. Climate
• Minerals
• Inorganic compounds that yield no energy; essential
• structural components involved in many body
• processes (see Table 4-2).
• Vitamins
• Organic compounds necessary in small quantities for
• cellular functions of the body; do not give energy;
• necessary in many enzyme systems (see Table 4-3).
• A. Fat-soluble vitamins (A, D, E, K): can be stored in
• body; toxic in large amounts.
• B. Water-soluble vitamins (B1 [thiamin];
• B2 [riboflavin]; B6 [pyridoxine];
• B12 [hydroxycobalamin]; C [ascorbic acid]; folacin
• niacin): cannot be stored in body so must be
• ingested daily; dissolves in cooking water, toxicity
• unlikely.

13. • Water
• A. Distribution: present in all body tissues; accounts
• for 50–60% total body weight in adults and
• 70–75% in infants.
• 1. Intracellular fluid: exists within the cells.
• 2. Extracellular fluid: includes plasma fluid,
• interstitial fluid, lymph, and secretions.
• B. Functions: the medium of all body fluids
• 1. Necessary for many biologic reactions.
• 2. Acts as a solvent.
• 3. Transports nutrients to cells and eliminates
• waste.
• 4. Body lubricant.
• 5. Regulates body temperature.
• C. Sources
• 1. Ingestion of water and other beverages
• 2. Water content of food eaten
• 3. Water resulting from food oxidation
• D. Recommended daily intake
• 1. Replacement of losses through the kidneys,
• lungs, skin, and bowel
• 2. Thirst usually a good guide
• 3. Approximately 48 oz/day of water from all
• sources is adequate; requirement is higher if
• physical activity is strenuous or if sweating is
• profuse.

14. • Nutritional Assessment
• Health History
• A. Presenting problem
• 1. Weight changes
• a. Usual body weight 20% above or below
• normal standards.
• b.Recent loss or gain of 10% of usual body
• weight.
• 2. Appetite changes: may increase or decrease
• from usual.
• 3. Food intolerances: allergies, fluids, fat, salt,
• seafood
• 4. Difficulty swallowing
• 5. Dyspepsia or indigestion
• 6. Bowel dysfunction: record frequency,
• consistency, color of stools.
• a. Constipation
• b. Diarrhea
• B. Lifestyle: eating behaviors such as fast foods, “junk foods,” and skipping meals;
cultural/religious
• concerns (vegetarian, kosher foods, exclusion of
• certain food groups); alcohol, socioeconomic
• status, living conditions (alone or with family).

15. • C. Use of medications: vitamin supplements,
• antacids, antidiarrheals, laxatives, diuretics,
• antihypertensives, immunosuppressants, oral
• contraceptives, antibiotics, antidepressants,
• digitalis, anti-inflammatory agents, catabolic
• steroids.
• D. Medical history: gastrointestinal diseases;
• endocrine diseases; hyperlipidemia; coronary
• artery disease; malabsorption syndrome;
• circulatory problems or heart failure; cancer;
• radiation therapy; chronic lung, renal, or liver
• disease; food allergies; recent major surgery; eating
• disorders; obesity.
• E. Family history: obesity, allergies, cardiovascular
• diseases, diabetes, thyroid disease.
• F. Dietary history: evaluation of the nutritional
• adequacy of diet
• 1. 24-hour recall
• 2. Food diary for a given number of days

16. • Physical Examination
• A. Assess for alertness and responsiveness
• B. Record weight in relation to height, body build,
• and age
• C. Inspect posture, muscle tone, skeleton for
• deformities
• D. Elicit reflexes
• E. Auscultate heart rate, rhythm; blood pressure
• F. Inspect hair, skin, nails, oral mucosa, tongue, tee
• G. Inspect for swelling of legs or feet
• H. Anthropometric measurements: indicators of
• available stores in muscle and fat compartments
• of body
• 1. Height/weight ratio (Body Mass Index [BMI]
• 2. Midarm muscle circumference
• 3.Skinfold thickness (triceps, biceps,
• subscapular, abdominal, hip, pectoral, or ca
• Laboratory/Diagnostic Tests
• A. Blood studies: serum albumin, iron-binding
• capacity, hemoglobin, hematocrit, lymphocyte
• count, blood sugar, total cholesterol, high-density
• lipids, low-density lipids, triglycerides, serum
• electrolytes
• B. Urine studies, urinalysis, glucose, ketones,
• albumin, 24-hour creatinine
• C. Nitrogen balance studies
• D. Feces, hair
• E. Intradermal delayed hypersensitivity testing

17. • Analysis
• Nursing diagnoses for the client with a nutritional
• dysfunction may include:
• A. Imbalanced nutrition: less than body requirements
• B. Imbalanced nutrition: more than body
• requirements
• C. Risk for imbalanced nutrition: more than body
• requirements
• D. Impaired oral mucous membrane
• E. Self-care deficit, feeding
• F. Disturbed sensory perceptions
• G. Risk for impaired skin integrity
• H. Impaired swallowing
• I. Impaired tissue integrity
• J. Activity intolerance
• K. Disturbed body image
• L. Constipation
• M. Diarrhea
• N. Deficient fluid volume
• O. Excess fluid volume
• P. Delayed growth and development
• Q. Risk for infection
• R. Deficient knowledge
• S. Noncompliance

18. • Planning and Implementation
• Goals
• A. Normal weight will be achieved and maintained.
• B. Integrity of oral cavity will be maintained.
• C. Client will feed self or receive help with feeding.
• D. Normal skin integrity will be
• achieved/maintained.
• E. Client will not aspirate.
• F. Normal tissue integrity will be
• achieved/maintained.
• G. Client will be able to exercise normally.
• H. Client will maintain/develop satisfactory
• self-image.
• I. Normal bowel functioning will be maintained.
• J. Fluid and electrolyte balance will be
• achieved/maintained.
• K. Client will have normal growth and development
• patterns.
• L. Client will not develop infection.
• M. Client will demonstrate knowledge of special
• dietary needs/prescriptions.
• N. Client will comply with special die

19. • Interventions
• Care of the Client on a Special Diet
• A. General information: therapeutic diets involve
• modifications of nutritional components
• necessitated by a client’s disease state or
• nutritional status or to prepare a client for a
• procedure.
• B. Nursing care in relation to special diets
• 1. Assess client’s mental, emotional, physical,
• and economic status; appropriateness of diet
• to client’s condition; and ability to understand
• diet and comply with it.
• 2. Maintain appropriate diet and teach client.
• 3. Changing diet means changing lifelong patterns.
• 4. Teach client importance of adhering to special
• diets that are long term.
• Weight Control Diets
• A. Underweight: 10% or more below individual’s
• ideal weight
• 1. Causes: failure to ingest enough kcal, excess
• energy expenditure, irregular eating habits, GI
• disturbances, mouth sores, cancer, endocrine
• disorders, emotional disturbances, lack of
• education, economic problems.
• 2. Treatment: diet counseling, correction of
• underlying disease, nutritional supplements,
• behavioral therapy, social service referral.

20. • B. Overweight: 10% or more above individual’s ideal
• weight
• C. Obesity: 20% or more above individual’s ideal
• weight
• 1. Causes: overeating, underactivity, genetic
• factors, fat cell theory, alteration in
• hypothalamic function, endocrine disorders,
• emotional disturbances.
• 2. Treatment: diet counseling, nutritionally
• balanced diet, behavior modification,
• increased physical activity, medical treatment
• of any underlying disease, appropriate
• referrals.
• D. Nursing care
• 1. Explain dietary instructions.
• a. Reducing fats and “empty calories”
• reduces caloric intake without sacrificing
• nutritional intake
• b. Increasing exercise increases metabolism
• 2. Caution against fad diets that may be
• nutritionally inadequate.
• 3. Encourage support groups if indicated.

21. • Diabetic Diet (Consistent carbohydrates)
• A. Prescribed for clients with diabetes mellitus.
• B. Purposes include: attain or maintain ideal body
• weight, ensure normal growth, maintain plasma
• glucose levels as close to normal as possible.
• C.Principles
• 1. Distribution of kcal: protein 12–20%;
• carbohydrates 55–60%; fats (unsaturated)
• 20–25%.
• 2. Daily distribution of kcal: equally divided
• among breakfast, lunch, supper, snacks.
• 3. Use foods high in fiber and complex
• carbohydrates.
• 4. Avoid simple sugars, jams, honey, syrup,
• frosting.
• D. Teach client to utilize exchange lists.
• E. New recommendations include low-fat, high fiber
• diet.
• Low-Sodium Diet (No-added-salt diet)
• A. Purpose is to restrict sodium intake to less than
• 2300 mg of sodium per day for clients with
• hypertension or cardiac disease.
• B. One method is the DASH (Dietary Approaches to
• Stop Hypertension) Eating Plan.
• C. Food choices
• 1. Choose and prepare food with little salt.
• 2. Continue to meet potassium requirement of
• 4700 mg/day.
• 3. Avoid table salt, processed meats, canned
• soups, snack food containing salt.
• 4. Teach client to read labels of prepared food.

22. • Protein-Modified Diets
• A. Gluten-free diet
• 1. Purpose is to eliminate gluten (a protein) from
• the diet.
• 2. Indicated in malabsorption syndromes such as
• sprue and celiac disease.
• 3. Eliminate all barley, rye, oats, and wheat
• (BROW).
• 4. Avoid: cream sauces, breaded foods, cakes,
• breads, muffins.
• 5. Allow corn, rice, and soy flour.
• 6. Teach client to read labels of prepared foods.
• B. PKU (Phenylketonuria) diet
• 1. Purpose is to control intake of phenylalanine,
• an amino acid that cannot be metabolized.
• 2. Diet will be prescribed until at least age 6 to
• prevent brain damage and mental retardation.
• 3. Avoid: breads, meat, fish, poultry, cheeses,
• legumes, nuts, eggs.
• 4. Give Lofenalac formula.
• 5. Teach family to use low-protein flour for
• baking.
• 6. Sugar substitutes such as Nutrasweet contain
• phenylalanine and must not be used.
• C. Low-purine diet
• 1. Indicated for gout, uric acid kidney stones,
• and uric acid retention.
• 2. Purpose is to decrease the amount of purine, a
• precursor to uric acid. 3. Teach client to avoid: organ meats, other
• meats, fowl, fish and lobster, lentils, dried
• peas and beans, nuts, oatmeal, whole wheat.
• 4. Eggs are not high in purine.

23. • -Restricted Diets
• Purpose is to restrict amount of fats ingested for
• clients with chronic pancreatitis, malabsorption
• syndromes, gallbladder disease, cystic fibrosis, and
• hyperlipidemia, and to control weight.
• Bariatric Diet
• A. Prescribed for clients after bariatric weight loss
• surgeries for obesity.
• B. After surgery, small stomach will hold about 1 oz.
• 1. First week: nutritious liquids; Second week:
• Pureed, high-protein foods
• 2. Avoid high carbohydrates
• 3. Possible complication: Dumping Syndrome
• (nausea, hypotension, hypoglycemia)
• 4. Client is educated before surgery about
• post-operative diet.
• Renal Diet
• A. Prescribed for clients with end-stage renal disease
• (ESRD).
• B. Principles
• 1. Prevent accumulation of protein waste
• between dialysis treatments.
• 2. Potassium is restricted to 3000–4000 mg/day.
• (Restrict milk intake to
• 1⁄2 cup/day due to high potassium content.)
• 3. Limit sodium to 3 grams/day (No-added-salt diet).
• 4. Teach client to measure proper food choices
• and to measure fluid intake and output

24. • Consistency Modifications
• A. Clear liquid diet
• 1. Purpose is to rest GI tract and maintain fluid
• balance.
• 2. Indications include difficulty chewing or
• swallowing; before certain diagnostic tests to
• reduce fecal material; immediate postoperative
• period (until bowel sounds have returned) to
• maintain electrolyte balance; and nausea,
• vomiting, and diarrhea.
• 3. Foods allowed: “see-through foods” include
• water, tea, broth, jello, apple juice, clear
• carbonated beverages, and frozen ice pops.
• 4. Not nutritionally adequate.

25. • B. Full liquid diet
• 1. Used as a transition diet between clear liquid
• and soft diet; usually short term.
• 2. Foods allowed: clear liquids, milk and milk
• products, all fruit juices, cooked and strained
• cereals.
• 3. Can be nutritionally adequate. C. Soft diet
• 1. Used as a transition diet between full liquid
• and regular diet.
• 2. Indications include postoperatively, mild GI
• disturbances, chewing difficulties from lack of
• teeth or oral surgery.
• 3. Foods allowed: foods low in fiber, connective
• tissue and fat (full liquid diet, pureed
• vegetables, eggs cooked any way except fried,
• tender meat, potatoes, cooked fruit).
• 4. Nutritionally adequate.
• D. Bland diet
• 1. Promotes healing of the gastric mucosa and is
• chemically and mechanically nonstimulating.
• 2. Foods allowed: soft diet without spices.

26. • E. Low-residue diet
• 1. Residue is the indigestible substances left in
• digestive tract after food has been digested.
• 2. Indications include colon, rectal, or perineal
• surgery to reduce pressure on the operative
• site; prior to examination of the lower bowel to
• enhance visualization; internal radiation for
• cancer of the cervix; Crohn’s disease or
• regional enteritis; ulcerative colitis to reduce
• irritation of the large bowel; and diarrhea.
• 3. Teach client to avoid foods high in fiber, foods
• having skins and seeds, and milk and milk
• products. Evaluation
• A. Client’s weight is within normal limits.
• B. No lesions in oral cavity.
• C. Client feeds self or receives needed assistance with
• feeding.
• D. Skin and tissue integrity is maintained.
• E. Client demonstrates ability to exercise.
• F. Client makes positive statements about self-image.
• G. Client’s bowel functioning is normal.
• H. Serum electrolytes are within normal limits.
• I. Client will exhibit growth and development
• patterns appropriate for age.
• J. Client shows no evidence of infection.
• K. Client states reason for special diet.
• L. Client describes foods allowed and not allowed on
• prescribed diet.
• M. Client adheres to prescribed diet.

27. • Enteral Nutrition
• Preferred method for nutritional support for the
• malnourished client whose GI system is intact.
• Oral Feeding
• A. Always the first choice.
• B. Oral formula supplements may be used between
• meals to provide added kcal and nutrients.
• 1. Offer small quantities several times a day.
• 2. Vary flavors, avoid taste fatigue.
• 3. Chill and serve over ice.
• Tube Feeding
• A. Used for clients who have a functioning GI tract
• but cannot ingest food orally
• 1. Feeding tubes
• a. Short term: nasogastric tube
• b. Long term: esophagostomy, gastrostomy, or
• enterostomy tube
• 2. Formulas: nutritionally adequate, tolerated by
• client, easily prepared, easily digested, usual
• concentration 1 kcal/mL
• 3. Feeding schedules
• a. Intermittent: usually 4–6 times per day,
• volumes up to 400 mL, by slow gravity
• drip over 30–60 minutes
• b. Continuous: usually administered by
• pump through a duodenal or proximal
• jejunostomy feeding tube
• 4. Nursing responsibilities
• a. Administer formulas at room temperature
• (refrigerate unused portion).
• b. Gradually increase rate and concentration
• until desired amount is attained if there are
• no signs of intolerance (e.g., gastric
• residual greater than 120 mL, nausea,
• vomiting, diarrhea, distention, diaphoresis
• increased pulse, glycosuria, aspiration).

28. • c. Check tube placement and elevate head of
• bed (see also Nasogastric Tubes).
• d. Monitor I&O, serum electrolytes, fractional
• urines, serum glucose, daily weights; keep
• a stool record as well as an ongoing
• assessment of tolerance. 4
• Parenteral Nutrition
• Nutrients are infused directly into a vein for clients who
• are unable to eat or digest food through the GI tract, who
• refuse to eat, or who have inadequate oral intake.
• Total Parenteral Nutrition (TPN)
• A. Involves the infusion of nutrients through a central
• vein catheter. A central vein is needed because its
• larger caliber and higher blood flow will quickly
• dilute the hypertonic hyperalimentation solution
• to isotonic concentrations.

29. • B. Hyperalimentation solutions
• 1. Hypertonic glucose of 20–70%, amino acids,
• water, vitamins, and minerals with lipid
• emulsions given in a separate solution.
• 2. Three-in-one solutions
• a. Lipids mixed with dextrose and amino
• acids in pharmacy.
• b. Prepared by pharmacy in a 3-liter
• container and administered over 24 hours.
• C. Nursing responsibilities
• 1. For details of nursing care of the client with a
• central venous line, see IV Therapy.
• 2. Inspect solution before hanging. a. Check for correct solution and additives
• against physician’s order.
• b. Check expiration date.
• c. Observe fluid for cloudiness or floating
• particulate matter.
• 3. Control flow rate of solution.
• a. Verify order and monitor flow rate.
• b. Administration via pump is required.
• c. Tubing with in-line filter is required.
• d. Never attempt to speed up or slow down
• infusion rate.
• 1) Speeding up infusion causes large
• amounts of glucose to enter body,
• causing hyperosmolar state.
• 2) Slowing down infusion can cause
• hypoglycemic state, as it takes time for
• the pancreas to adjust to reduced

30. • 4. Monitor fluid balance.
• 5. Assess client for signs and symptoms of
• infection (fever, chills, elevated WBC count).
• 6. Obtain fractional urines or Accu-Chek every
• 6 hours.
• 7. Administer sliding scale insulin for
• hyperglycemia, as ordered.
• 8. Provide psychological support.
• 9. Encourage exercise regimen. IV Lipid Emulsions
• A. May be given through a central vein or
• peripherally in order to prevent essential fatty acid
• deficiency in long-term TPN clients, or to provide
• supplemental kcal IV.
• B. Nursing care
• 1. Protect the stability of the emulsion.
• a. Administer in its own separate IV bottle
• and IV tubing, and piggyback the emulsion
• into the Y connector closest to the catheter
• insertion. Follow hospital policy and
• manufacturer’s recommendations for
• specific products. Some hospital facilities
• combine TPN and lipid into one bag.

31. • b. Inspect solution for evidence of separation
• of oil, frothiness, inconsistency, particulate
• matter; discard solution if any of these
• signs of instability occur.
• c. Do not shake the bottle; this might cause
• aggregation of fat globules.
• d. Discard partially used bottles.
• 2. Control the infusion rate accurately and safely.
• a. If using gravity method, lipid emulsion
• must hang higher than hyperalimentation
• to prevent backflow.
• b. Pump is preferred but may not be possible
• due to viscous nature of emulsion.
• 3. Prevent and assess for adverse reactions.
• a. Administer slowly according to package
• insert over first 30 minutes; if no adverse
• reactions, increase rate to completeinfusion over the specified number of
• hours.
• b. Obtain baseline vital signs; repeat after first
• 30 minutes, and then every 4 hours until
• completion.

32. • c. Acute reactions may include: fever, chills,
• dyspnea, nausea, vomiting, headache,
• lethargy, syncope, chest or back pain,
• hypercoagulability, thrombocytopenia.
• 4. Evaluate tolerance and client response.
• Peripheral Vein Parenteral Nutrition (PPN)
A. Can be used for short-term support, when the
• central vein is not available, and as a supplemental
• means of obtaining nutrients. Client must be able
• to tolerate a relatively high fluid volume.
• B. Solution contains the same components as central
• vein therapy, but lower concentrations (less than
• 20% glucose).
• C. Care is the same as for the client receiving
• hyperalimentation centrally.
• D. Phlebitis and thrombosis are common and IV sites
• will need frequent changing.

33. • Questions
• 1.methods of nutrition.
• 2.Places of body temprature measurement.
• 3.Janet syringe for what/whom was proposed.
• 4.bedsores/measures to prevent.
• 5.Role of carbohydrates.
• 6.Classification of Vladimir Vernadsky.
• 7.Main principles in examination of oral cavity.