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NUTRITION
NUTRITION
Nutrition is the science of food and
nutrients and it includes the process of
utilizing it by the humans
IMPORTANCE
– Food is one of the fundamental needs of all
living organisms
– Food is important for human beings through
out wellness-illness continuum
– Diet therapy is a major treatment for disease
control (Eg: HTN , DM)
NUTRITIONAL STATUS
Is the state of body resulting from the use
of nutrients available in the body
• Food is composed of nutrients necessary for
the body process and functions
– Carbohydrates Macronutrients
– Proteins
– Fats
– Vitamins and minerals
– Water Micronutrients
NUTRIENTS
–Carbohydrates: Energy
–Proteins :Body building
–Fats :Energy
–Vitamins and minerals: Normal
metabolic process including acid base
balance
–Water :Solvent for metabolic processes
Sources
Factors affecting nutritional needs
• Anorexia :loss of appetite
• Psychosocial problems:
(Fear ,Anxiety, Depression and Pain)
• Problems in the sense of smell and taste
• Secondary effects of drug therapy or treatment
• Patient with difficulty in swallowing and chewing
• Chronic GI problems
• Post-operative patients
• Patient from low socioeconomic status
• Certain beliefs of patients
Factors affecting nutritional intake
• Decreased food intake
– Anorexia
– Psychosocial factors
– Impaired ability to smell and taste
– Can develop secondary effect to drug therapy or
medical treatments
– Swallowing difficulty
– GI problems
– Surgery
– Poverty
– Consciousness
General assessment of
nutritional status
• Components
– Health history
– Evaluation of food
intake
– Physical
examination
– Diagnostic tests
Methods
•24 hr recall method
•Food frequency questionnaire
•Food diary
•House hold food consumption
Dietary history
24 hr recall method
Food diary
House hold food consumption
Methods
– Food group method
– Nutrient composition
method
– Calorie count
Evaluation of food intake
Physical examination
• Anthropometric measurements
– Height and weight
– BMI : 18.5-24.5
– Body composition
• Triceps skin fold measurement
• Mid-arm circumference
Triceps skin fold measurement
Mid-arm circumference
Diagnostic tests
• Serum prealbumin
• Albumin
• Transferrin
• Lymphocyte count
• Hemoglobin
• Haematocrit
• Urine specific gravity
• 24 hr urine tests
Signs of poor nutrition
• Hair : thin, coarse, lacking luster, breaks easily.
• Skin : excessive bruising, bleeding, pressure
sores, poor wound healing.
• Muscles : wasting, lack of growth
• Skeletal : poor posture, painful joints, bowed
legs, increase in bone fracture
• Mental: confusion, motor weakness
Diagnosing
• Imbalanced Nutrition: More Than
Body Requirements
• Imbalanced Nutrition: Less Than
Body Requirements
• Readiness for Enhanced Nutrition
• Risk for Imbalanced Nutrition: More
Than Body Requirements
Diagnosing
• Diagnostic label used as etiology
– Activity Intolerance
– Constipation
– Low Self-Esteem
– Risk for Infection
Planning
• Maintain or restore optimal
nutritional status
• Promote healthy nutritional practices
• Prevent complications associated
with malnutrition
• Decrease weight or regain specified
weight
Planning
• Planning for home care
– Provide aid with eating, purchasing
food, and preparing meals
– Instruct about nutrition therapy
– Assess client and family's abilities for
self-care, financial resources, and need
for referrals
Implementing
• Hospitalized client
– Provided in collaboration with the
primary care provider and the dietitian
– Reinforce information presented by
dietitian
– Create an atmosphere that encourages
eating
– Provide and assist with eating as
needed
continued on next slide
Implementing
• Hospitalized client
– Monitor the client's appetite and food
intake
– Administer enteral and parenteral
feedings
– Consult with primary care provider and
dietitian about nutritional problems
Implementing
• Assisting with special diets
– Altered diets used to treat disease,
increase/decrease weight, restore
nutritional deficit, allow organ to
rest/heal
– Diets modified in texture, kilocalories,
specific nutrients, seasonings,
consistency
continued on next slide
Implementing
• special diets
– Clear liquid diet
• Fluid and carbohydrates
• No adequate protein, fat, vitamins,
minerals, calories
– Full liquid diet
• Liquids or foods that turn liquid at body
temperature
• Clients with GI disturbances
continued on next slide
Implementing
• special diets
– Soft diet
• Low residue (low-fiber)
– Diet as tolerated
• Advance the diet if the patient is responding
as expected
continued on next slide
Implementing
• Assisting with special diets
– Modification for disease
• Altered metabolism
• Diabetic diet is a lifetime diet.
– Dysphagia
• Older clients, clients with cancer
• Nurses may be first to detect.
• Levels of liquid foods are thin, nectar-like,
honey-like, and spoon-thick liquids
Implementing
• Stimulating the appetite
– Decrease in food intake often
accompanied by decrease in fluid
intake.
– Short-term decrease not a problem, but
over time it leads to nutritional
problems.
– Determine reason for lack of appetite,
then deal with problem
Implementing
• Assisting clients with meals
• Be sensitive to client's feelings of
embarrassment
• Help client to feed self
• Ask order in which client would like to eat
• Use normal utensils whenever possible
• Special community nutritional services
• Meals on Wheels
Implementing
• Enteral nutrition
– Enteral
• Through the GI system
– Enteral access devices
• Nasogastric tube
• Nasoenteric (nasointestinal) tube
• Gastrostomy and jejunostomy devices
continued on next slide
Implementing
• Enteral nutrition
– Enteral access devices
• Percutaneous endoscopic gastrostomy (PEG)
• Percutaneous endoscopic jejunostomy (PEJ)
Conclusion
Nutrition

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Nutrition

  • 2. NUTRITION Nutrition is the science of food and nutrients and it includes the process of utilizing it by the humans
  • 3. IMPORTANCE – Food is one of the fundamental needs of all living organisms – Food is important for human beings through out wellness-illness continuum – Diet therapy is a major treatment for disease control (Eg: HTN , DM)
  • 4. NUTRITIONAL STATUS Is the state of body resulting from the use of nutrients available in the body • Food is composed of nutrients necessary for the body process and functions – Carbohydrates Macronutrients – Proteins – Fats – Vitamins and minerals – Water Micronutrients
  • 5. NUTRIENTS –Carbohydrates: Energy –Proteins :Body building –Fats :Energy –Vitamins and minerals: Normal metabolic process including acid base balance –Water :Solvent for metabolic processes
  • 7. Factors affecting nutritional needs • Anorexia :loss of appetite • Psychosocial problems: (Fear ,Anxiety, Depression and Pain) • Problems in the sense of smell and taste • Secondary effects of drug therapy or treatment • Patient with difficulty in swallowing and chewing • Chronic GI problems • Post-operative patients • Patient from low socioeconomic status • Certain beliefs of patients
  • 8. Factors affecting nutritional intake • Decreased food intake – Anorexia – Psychosocial factors – Impaired ability to smell and taste – Can develop secondary effect to drug therapy or medical treatments – Swallowing difficulty – GI problems – Surgery – Poverty – Consciousness
  • 10. • Components – Health history – Evaluation of food intake – Physical examination – Diagnostic tests
  • 11. Methods •24 hr recall method •Food frequency questionnaire •Food diary •House hold food consumption Dietary history
  • 12. 24 hr recall method
  • 13.
  • 15. House hold food consumption
  • 16. Methods – Food group method – Nutrient composition method – Calorie count Evaluation of food intake
  • 17. Physical examination • Anthropometric measurements – Height and weight – BMI : 18.5-24.5 – Body composition • Triceps skin fold measurement • Mid-arm circumference
  • 18. Triceps skin fold measurement
  • 20. Diagnostic tests • Serum prealbumin • Albumin • Transferrin • Lymphocyte count • Hemoglobin • Haematocrit • Urine specific gravity • 24 hr urine tests
  • 21. Signs of poor nutrition • Hair : thin, coarse, lacking luster, breaks easily. • Skin : excessive bruising, bleeding, pressure sores, poor wound healing. • Muscles : wasting, lack of growth • Skeletal : poor posture, painful joints, bowed legs, increase in bone fracture • Mental: confusion, motor weakness
  • 22. Diagnosing • Imbalanced Nutrition: More Than Body Requirements • Imbalanced Nutrition: Less Than Body Requirements • Readiness for Enhanced Nutrition • Risk for Imbalanced Nutrition: More Than Body Requirements
  • 23. Diagnosing • Diagnostic label used as etiology – Activity Intolerance – Constipation – Low Self-Esteem – Risk for Infection
  • 24. Planning • Maintain or restore optimal nutritional status • Promote healthy nutritional practices • Prevent complications associated with malnutrition • Decrease weight or regain specified weight
  • 25. Planning • Planning for home care – Provide aid with eating, purchasing food, and preparing meals – Instruct about nutrition therapy – Assess client and family's abilities for self-care, financial resources, and need for referrals
  • 26. Implementing • Hospitalized client – Provided in collaboration with the primary care provider and the dietitian – Reinforce information presented by dietitian – Create an atmosphere that encourages eating – Provide and assist with eating as needed continued on next slide
  • 27. Implementing • Hospitalized client – Monitor the client's appetite and food intake – Administer enteral and parenteral feedings – Consult with primary care provider and dietitian about nutritional problems
  • 28. Implementing • Assisting with special diets – Altered diets used to treat disease, increase/decrease weight, restore nutritional deficit, allow organ to rest/heal – Diets modified in texture, kilocalories, specific nutrients, seasonings, consistency continued on next slide
  • 29. Implementing • special diets – Clear liquid diet • Fluid and carbohydrates • No adequate protein, fat, vitamins, minerals, calories – Full liquid diet • Liquids or foods that turn liquid at body temperature • Clients with GI disturbances continued on next slide
  • 30. Implementing • special diets – Soft diet • Low residue (low-fiber) – Diet as tolerated • Advance the diet if the patient is responding as expected continued on next slide
  • 31. Implementing • Assisting with special diets – Modification for disease • Altered metabolism • Diabetic diet is a lifetime diet. – Dysphagia • Older clients, clients with cancer • Nurses may be first to detect. • Levels of liquid foods are thin, nectar-like, honey-like, and spoon-thick liquids
  • 32. Implementing • Stimulating the appetite – Decrease in food intake often accompanied by decrease in fluid intake. – Short-term decrease not a problem, but over time it leads to nutritional problems. – Determine reason for lack of appetite, then deal with problem
  • 33. Implementing • Assisting clients with meals • Be sensitive to client's feelings of embarrassment • Help client to feed self • Ask order in which client would like to eat • Use normal utensils whenever possible • Special community nutritional services • Meals on Wheels
  • 34. Implementing • Enteral nutrition – Enteral • Through the GI system – Enteral access devices • Nasogastric tube • Nasoenteric (nasointestinal) tube • Gastrostomy and jejunostomy devices continued on next slide
  • 35. Implementing • Enteral nutrition – Enteral access devices • Percutaneous endoscopic gastrostomy (PEG) • Percutaneous endoscopic jejunostomy (PEJ)