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Basic Nutrition and Basic Nutrition and Nutritional Therapy Nutritional Therapy Foundations of Foundations of Nursing Nursing Christensen Christensen Kockrow Kockrow Mosby 5 Mosby 5th th edition edition Sharon Kinley-Schwing BSN Pacific College 2006
Prevention = nutrition one of the most important parts of health Prevention = nutrition one of the most important parts of health care. care. Nutrition is the total of all processes involved in the taking in and Nutrition is the total of all processes involved in the taking in and utilization of food substances for proper growth, functioning, and utilization of food substances for proper growth, functioning, and maintenance of health. maintenance of health. Nutrition plays a role directly or indirectly in all body processes, and Nutrition plays a role directly or indirectly in all body processes, and disease states. disease states. Proper nutrition may help prevent or delay onset of many diseases. Proper nutrition may help prevent or delay onset of many diseases. Nutrition is the most over looked part of healthy living. Nutrition is the most over looked part of healthy living.
Role of the Nurse in Promotion Nutrition Role of the Nurse in Promotion Nutrition The nurse can promote good nutrition by: The nurse can promote good nutrition by: – Helping the patient understand the importance of the diet and Helping the patient understand the importance of the diet and encouraging dietary compliance. encouraging dietary compliance. – Serving meal trays to patients in a prompt and positive Serving meal trays to patients in a prompt and positive manner. manner. – Assisting some patients with the eating process. Assisting some patients with the eating process. – Taking and recording patient weight. Taking and recording patient weight. – Recording patient intake. Recording patient intake. – Observing clinical signs of poor nutrition and reporting them. Observing clinical signs of poor nutrition and reporting them. – Serving as a communication link. Serving as a communication link. – Nurse can apply nutrition to their personal lives, what a Nurse can apply nutrition to their personal lives, what a better reason to understand nutrition for your own health. better reason to understand nutrition for your own health.
NUTRITION NUTRITION All of the processes involved in consuming All of the processes involved in consuming and utilizing food for energy, and utilizing food for energy, maintenance, and growth. maintenance, and growth. These processes are ingestion, digestion, These processes are ingestion, digestion, absorption, metabolism, and excretion. absorption, metabolism, and excretion.
INGESTION INGESTION The taking of food into the digestive The taking of food into the digestive tract, generally through the mouth. tract, generally through the mouth. In special circumstances, ingestion In special circumstances, ingestion occurs directly into the stomach, occurs directly into the stomach, through a feeding tube. through a feeding tube.
DIGESTION DIGESTION Mechanical and chemical processes Mechanical and chemical processes converting nutrients to a physically converting nutrients to a physically absorbable state: absorbable state: – Mastication–chewing Mastication–chewing – Deglutition–swallowing Deglutition–swallowing – Peristalsis–rhythmic, coordinated, serial Peristalsis–rhythmic, coordinated, serial contractions of smooth muscles of GI tract contractions of smooth muscles of GI tract
ABSORPTION ABSORPTION The process whereby the end products of The process whereby the end products of digestion pass through the epithelial digestion pass through the epithelial membranes in small and large intestines membranes in small and large intestines and into blood or lymph systems. and into blood or lymph systems. Villi–small finger-like projections that line Villi–small finger-like projections that line the small intestine. Most nutrients are the small intestine. Most nutrients are absorbed directly through the villi. absorbed directly through the villi.
METABOLISM METABOLISM The conversion of nutrients into energy. The conversion of nutrients into energy. Anabolism–the constructive process of metabolism, Anabolism–the constructive process of metabolism, requires energy. requires energy. Catabolism–the destructive process of metabolism, Catabolism–the destructive process of metabolism, releases energy. releases energy. Basal metabolism–the energy needed to maintain Basal metabolism–the energy needed to maintain essential physiologic functions. essential physiologic functions.
EXCRETION EXCRETION The process of eliminating or The process of eliminating or removing waste products from removing waste products from the body. the body.
NUTRIENTS NUTRIENTS Water Water Carbohydrates Carbohydrates Fats Fats Proteins Proteins Vitamins Vitamins Minerals Minerals The body must have six types of nutrients to The body must have six types of nutrients to function efficiently and effectively: function efficiently and effectively:
Dietary Guidelines for Americans: Dietary Guidelines for Americans: These guidelines form the foundation of U.S. federal These guidelines form the foundation of U.S. federal nutrition policy and directly affect federal nutrition nutrition policy and directly affect federal nutrition programs such as food stamps, school breakfast and programs such as food stamps, school breakfast and lunch programs, and the Special Supplemental lunch programs, and the Special Supplemental Program for Women, Infants, and Children (WIC). Program for Women, Infants, and Children (WIC). These guidelines have been developed to address the These guidelines have been developed to address the importance of adequate nutrition, as well as the importance of adequate nutrition, as well as the prevention of over nutrition and disease. prevention of over nutrition and disease. Dietary Reference Intakes: Dietary Reference Intakes: This is a set of nutrient-based values that can be used for This is a set of nutrient-based values that can be used for both assessing and planning diets. both assessing and planning diets. They form the basis for daily values used in the They form the basis for daily values used in the Nutrition Facts labels on foods. Nutrition Facts labels on foods. The DRIs are intended to help individuals optimize The DRIs are intended to help individuals optimize their health, prevent disease, and avoid consuming their health, prevent disease, and avoid consuming too much of a nutrient. too much of a nutrient.
Essential Nutrients Essential Nutrients – Basic Functions: Basic Functions: Essential nutrients are those that our bodies cannot make in Essential nutrients are those that our bodies cannot make in amounts necessary for good health. amounts necessary for good health. The six classes of essential nutrients are carbohydrates, The six classes of essential nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water. fats, proteins, vitamins, minerals, and water. Provide energy Provide energy – Carbohydrates and proteins: 4 kcal/g Carbohydrates and proteins: 4 kcal/g – Fat: 9 kcal/g Fat: 9 kcal/g Build and repair tissue Build and repair tissue – Protein, calcium, phosphorus, iron, and fat Protein, calcium, phosphorus, iron, and fat Regulate body processes Regulate body processes – Metabolism: the combination of all chemical processes Metabolism: the combination of all chemical processes that take place in living organisms that take place in living organisms
CARBOHYDRATES CARBOHYDRATES Made of the elements carbon, hydrogen, Made of the elements carbon, hydrogen, and oxygen (CHO) and oxygen (CHO) Constitute the chief source of energy for Constitute the chief source of energy for all body functions. all body functions. Requirements are 50–60% of total kcal Requirements are 50–60% of total kcal intake per day. intake per day.
Carbohydrates Carbohydrates Carbohydrates: Carbohydrates: Simple Carbohydrates: Simple Carbohydrates: Complex Carbohydrates: Complex Carbohydrates: Digestion and Metabolism of Carbohydrates: Digestion and Metabolism of Carbohydrates:
CARBOHYDRATE FUNCTIONS CARBOHYDRATE FUNCTIONS Primary source of energy for the body. Primary source of energy for the body. About half-day supply stored in liver and About half-day supply stored in liver and muscles for use as needed. muscles for use as needed. Spares proteins from being used for energy. Spares proteins from being used for energy. Needed to oxidize fats and for synthesis of fatty Needed to oxidize fats and for synthesis of fatty acids and amino acids. acids and amino acids.
Carbohydrate Absorption & Storage Carbohydrate Absorption & Storage Digestion begins in mouth, little takes place in Digestion begins in mouth, little takes place in the stomach, is completed in the small the stomach, is completed in the small intestine. intestine. Leave no waste for kidneys to eliminate. Leave no waste for kidneys to eliminate. Absorption takes place in the villi. Absorption takes place in the villi. Excess converted to glycogen and stored in Excess converted to glycogen and stored in the liver or stored as fat. the liver or stored as fat.
DEFICIENCY AND EXCESS DEFICIENCY AND EXCESS Mild deficiency can cause weight loss Mild deficiency can cause weight loss and fatigue. and fatigue. Serious deficiency can cause ketosis. Serious deficiency can cause ketosis. Excess can cause obesity, tooth Excess can cause obesity, tooth decay, irritate the lining of the decay, irritate the lining of the stomach, or flatulence. stomach, or flatulence.
FATS FATS Most concentrated energy source in diet. Most concentrated energy source in diet. Provides 9 kcal per gram. Provides 9 kcal per gram. Also known as lipids. Also known as lipids. Composed of carbon, hydrogen, and less oxygen Composed of carbon, hydrogen, and less oxygen than carbohydrates. than carbohydrates. Recommended: no more than 25–30% of daily Recommended: no more than 25–30% of daily intake. intake.
Fats (Lipids) Fats (Lipids) Lipids: Lipids: Saturated fatty acids: Saturated fatty acids: Unsaturated fatty acids: Unsaturated fatty acids: Trans Fatty Acids: Trans Fatty Acids: Cholesterol: Cholesterol: Digestion and Metabolism of fat: Digestion and Metabolism of fat:
Summary of Fatty Acid Classification Summary of Fatty Acid Classification Saturated Saturated Monounsaturated: Monounsaturated: Polyunsaturated: Polyunsaturated: Trans: Trans:
Classification of LDL, Total HDL, Cholesterol Classification of LDL, Total HDL, Cholesterol LDL Cholesterol: LDL Cholesterol: Total Cholesterol: Total Cholesterol: HDL Cholesterol: HDL Cholesterol:
Functions of Fat Functions of Fat Provides concentrated source of energy. Provides concentrated source of energy. Needed to absorb fat-soluble vitamins. Needed to absorb fat-soluble vitamins. Major component of cell membranes and myelin Major component of cell membranes and myelin sheaths. sheaths. Improves flavor, delays emptying time. Improves flavor, delays emptying time. Protects and helps hold organs in place. Protects and helps hold organs in place. Insulates the body. Insulates the body.
CLASSIFICATION CLASSIFICATION Triglycerides (true fats) are composed of one Triglycerides (true fats) are composed of one glycerol molecule attached to three fatty- glycerol molecule attached to three fatty- acid molecules. acid molecules. Phospholipids (lipoids) are composed of Phospholipids (lipoids) are composed of glycerol, fatty acids, and phosphorus. glycerol, fatty acids, and phosphorus. Cholesterol (sterol) liver produces over 1000 Cholesterol (sterol) liver produces over 1000 mg every day. mg every day.
Absorption and Storage Absorption and Storage No breakdown occurs in the mouth, very little No breakdown occurs in the mouth, very little digestion occurs in the stomach. digestion occurs in the stomach. Digestion begins in the small intestine. Digestion begins in the small intestine. Final products of fat digestion are fatty acids and Final products of fat digestion are fatty acids and glycerol. glycerol. 95% absorbed in small intestine. 95% absorbed in small intestine. Excess fats stored as adipose tissue. Excess fats stored as adipose tissue.
Deficiency and Excess Deficiency and Excess Deficiency occurs when fats provide less Deficiency occurs when fats provide less than 10% of the total daily kcal than 10% of the total daily kcal requirement. requirement. May result in eczema, retarded growth, May result in eczema, retarded growth, weight loss. weight loss. Excess can lead to overweight and heart Excess can lead to overweight and heart disease. disease.
Sources of Fat Sources of Fat Animal fats–lard, butter, milk, cream, Animal fats–lard, butter, milk, cream, egg yolks, meat, poultry, and fish. egg yolks, meat, poultry, and fish. Plant fats–corn oil, safflower oil, olive Plant fats–corn oil, safflower oil, olive oil, cottonseed oil, peanut oil, palm oil, oil, cottonseed oil, peanut oil, palm oil, and coconut oil, nuts, and avocado. and coconut oil, nuts, and avocado.
Protein Protein Amino Acids: Amino Acids: Complete proteins: Complete proteins: Incomplete proteins: Incomplete proteins: Vegetarian diets: Vegetarian diets: Digestion and Metabolism of Protein: Digestion and Metabolism of Protein: Protein-Kilocalorie malnutrition: Protein-Kilocalorie malnutrition:
Proteins Proteins Made of carbon, hydrogen, oxygen, and Made of carbon, hydrogen, oxygen, and nitrogen (CHON). nitrogen (CHON). The only nutrient that can build, repair, and The only nutrient that can build, repair, and maintain body tissues. maintain body tissues. Daily requirement for average adults is 0.8g Daily requirement for average adults is 0.8g of protein for each kilogram of body weight. of protein for each kilogram of body weight.
Functions Of Proteins Functions Of Proteins Provide amino acids, needed to build, repair, and Provide amino acids, needed to build, repair, and maintain body tissues. maintain body tissues. Assist in regulating fluid balance. Assist in regulating fluid balance. Vital part of enzymes, hormones, blood plasma. Vital part of enzymes, hormones, blood plasma. Used to build antibodies. Used to build antibodies. Can be converted to glucose, for energy. Can be converted to glucose, for energy.
Protein Digestion and absorption Protein Digestion and absorption Begins in the stomach. Begins in the stomach. Most digestion takes place in small intestine. Most digestion takes place in small intestine. End product is amino acids, absorbed into End product is amino acids, absorbed into the blood by the villi in the small intestine. the blood by the villi in the small intestine. Excess amino acids are converted to glucose, Excess amino acids are converted to glucose, glycogen, or fat for storage. glycogen, or fat for storage.
Sign of Deficiency and Excess Sign of Deficiency and Excess Muscle wasting. Muscle wasting. Edema. Edema. Lethargy and depression. Lethargy and depression. Marasmus and Kwashiorkor. Marasmus and Kwashiorkor. Excess can contribute to heart disease, and may be Excess can contribute to heart disease, and may be linked to colon cancer, osteoporosis, and kidney linked to colon cancer, osteoporosis, and kidney damage. damage.
Vitamins and Minerals Vitamins and Minerals They are needed in small amounts; toxicity may occur They are needed in small amounts; toxicity may occur with over consumption. with over consumption. They are best received from a balanced, varied diet. They are best received from a balanced, varied diet. Vitamins can be destroyed by heat, light, and exposure Vitamins can be destroyed by heat, light, and exposure to air. to air. Minerals cannot be destroyed because they are single Minerals cannot be destroyed because they are single elements rather than compounds. elements rather than compounds. Both vitamins and minerals can be lost when foods are Both vitamins and minerals can be lost when foods are cooked in water. cooked in water.
VITAMINS VITAMINS Organic compounds essential to life and health. Organic compounds essential to life and health. Regulate body processes, needed in very small Regulate body processes, needed in very small amounts. amounts. No fuel value but required for metabolism of No fuel value but required for metabolism of fats, carbohydrates, proteins. fats, carbohydrates, proteins. Functions are unique to each vitamin. Functions are unique to each vitamin.
–Fat soluble: Fat soluble: A, D, E, and K. A, D, E, and K. Usually carried in the fatty Usually carried in the fatty portion of food. portion of food. Can be stored by the body. Can be stored by the body. –Water soluble: Water soluble: B vitamins and C. B vitamins and C. Not stored in the body; excesses Not stored in the body; excesses excreted in the urine. excreted in the urine.
Digestion of Vits Digestion of Vits Vitamins do not require digestion. Vitamins do not require digestion. Fat-soluble vitamins are absorbed into the Fat-soluble vitamins are absorbed into the lymphatic system, excesses are stored in lymphatic system, excesses are stored in the liver and adipose tissue. the liver and adipose tissue. Water-soluble vitamins are absorbed Water-soluble vitamins are absorbed directly into the circulatory system, and directly into the circulatory system, and excesses are excreted in urine. excesses are excreted in urine.
Deficiency/ Excess Deficiency/ Excess Vitamin deficiencies can occur and Vitamin deficiencies can occur and result in disease. result in disease. Vitamins consumed in excess Vitamins consumed in excess amounts can be toxic to the body. amounts can be toxic to the body.
Minerals Minerals Inorganic elements that help regulate body Inorganic elements that help regulate body processes and /or serve as structural processes and /or serve as structural components of the body. components of the body. Major minerals–more than 100 mg/day. Major minerals–more than 100 mg/day. Trace minerals–less than 100 mg/day. Trace minerals–less than 100 mg/day. Functions are unique to each individual Functions are unique to each individual mineral. mineral.
Classification and Sources Classification and Sources Classified as major minerals or trace minerals. Classified as major minerals or trace minerals. Found in water and in unprocessed foods. Found in water and in unprocessed foods. Some foods are enriched—some vitamins are Some foods are enriched—some vitamins are added to them. added to them. Supplements may be needed during growth Supplements may be needed during growth periods, some clinical situations. periods, some clinical situations.
Digestion Digestion The amount of a mineral absorbed by The amount of a mineral absorbed by the body is influenced by: the body is influenced by: Type of food Type of food Need of body Need of body Health of absorbing tissue Health of absorbing tissue
Deficiency and Excess Deficiency and Excess Deficiency signs unique to each mineral. Deficiency signs unique to each mineral. Excesses can lead to toxicity. Excesses can lead to toxicity. Concentrated forms of minerals should Concentrated forms of minerals should be used only on advice of a physician. be used only on advice of a physician. Excesses can cause hair loss, changes Excesses can cause hair loss, changes in the blood, hormones, bones, muscles, and in the blood, hormones, bones, muscles, and nearly all tissues. nearly all tissues.
Vitamins Vitamins Antioxidant vitamins: Antioxidant vitamins: Vitamin A: Vitamin A: Vitamin C: Vitamin C: Vitamin D: Vitamin D: Vitamin E: Vitamin E:
Vitamin K: Vitamin K: Folate Acid: Folate Acid: Thiamine: Thiamine: Vitamin B 12: Vitamin B 12: Riboflavin: Riboflavin: Niacin: Niacin:
Vitamin B6: Vitamin B6: Biotin: Biotin: Choline: Choline: Pantothenic Acid: Pantothenic Acid: Vitamin C: Vitamin C:
Mineral Mineral Calcium Calcium Phosphorus: Phosphorus: Magnesium: Magnesium: Sulfur: Sulfur: Sodium: Sodium:
Potassium: Potassium: Chloride: Chloride: Iron: Iron: Zinc: Zinc: Iodine: Iodine: Selenium: Selenium:
Copper: Copper: Fluoride: Fluoride: Chromium: Chromium: Manganese Manganese: :
WATER ! WATER ! Nutrient most vital to life. Nutrient most vital to life. Makes up approximately 60% of adult body Makes up approximately 60% of adult body weight and 80% of infant weight. weight and 80% of infant weight. Provides form and structure to body tissues. Provides form and structure to body tissues.
Acts as a solvent; necessary for most chemical Acts as a solvent; necessary for most chemical processes. processes. Transports nutrients and other substances. Transports nutrients and other substances. Lubricates and protects moving parts of the Lubricates and protects moving parts of the body. body. Lubricates food and aids in digestion. Lubricates food and aids in digestion. Regulates body temperature Regulates body temperature
SOURCES OF WATER FOR THE BODY SOURCES OF WATER FOR THE BODY Liquids consumed, including water, coffee, Liquids consumed, including water, coffee, juice, tea, milk and soft drinks. juice, tea, milk and soft drinks. Foods consumed, especially vegetables and Foods consumed, especially vegetables and fruits. fruits. Metabolism, which produces water when Metabolism, which produces water when oxidization occurs. oxidization occurs.
WATER DIGESTION/ ABSORPTION,/STORAGE WATER DIGESTION/ ABSORPTION,/STORAGE Water is absorbed, not digested. Water is absorbed, not digested. It is not stored and is excreted daily. It is not stored and is excreted daily. Sensible loss–aware of loss of water. Sensible loss–aware of loss of water. Insensible loss–not aware of loss of water. Insensible loss–not aware of loss of water. Urine, feces, perspiration, and respiration are the four Urine, feces, perspiration, and respiration are the four ways the body loses water. ways the body loses water.
SIGNS OF SIGNS OF Dehydration: Dehydration: – Deficiency of water, can cause death. Deficiency of water, can cause death. – Occurs from profuse sweating, vomiting, Occurs from profuse sweating, vomiting, diarrhea, hemorrhage, wound drainage, diarrhea, hemorrhage, wound drainage, fever, and edema. fever, and edema. Positive water balance when more water Positive water balance when more water taken in than used or excreted. taken in than used or excreted.
Selected Foods with Vit. C: Selected Foods with Vit. C: Selected Foods with Vit. D: Selected Foods with Vit. D: Factors that affect Calcium Absorption and Factors that affect Calcium Absorption and Excretion: Excretion: Factors that affect iron Absorption: Factors that affect iron Absorption:
Basic Nutrition Basic Nutrition
Diet Planning Guides Diet Planning Guides A number of guidelines have been established in A number of guidelines have been established in the US to help guide Americans in healthy and the US to help guide Americans in healthy and balanced eating. balanced eating. – My Pyramid: My Pyramid: Bread, cereal, rice, and pasta group. Bread, cereal, rice, and pasta group. Vegetable group. Vegetable group. Fruit group. Fruit group. Milk, yogurt, and cheese group. Milk, yogurt, and cheese group. Meat, poultry, fish, dried beans, eggs, and Meat, poultry, fish, dried beans, eggs, and nuts group. nuts group. Fats, oils, and sweets. Fats, oils, and sweets.
MyPyramid, a personalized guide to daily food choices and number of servings. (From US Department of Agriculture, Washington, DC, 2005, US Government Printing Office.)
MyPyramid MyPyramid U.S. Department of Agricultures, Pyramid symbolizes a personalized U.S. Department of Agricultures, Pyramid symbolizes a personalized approach to health eating and physical activity. approach to health eating and physical activity. MyPyramid emphasizes key concepts in physical activity and eating. MyPyramid emphasizes key concepts in physical activity and eating. Moderation is represented by the narrowing of each food group. Moderation is represented by the narrowing of each food group. The wider base stands for food with little or no solid fats or added The wider base stands for food with little or no solid fats or added sugars. sugars. The Narrower top area is food with more added sugars and solid The Narrower top area is food with more added sugars and solid fats. fats. Varity and proportionality is shown by different widths of food groups. Varity and proportionality is shown by different widths of food groups. This pyramid can be personalized at www.mypyramid.gov. This pyramid can be personalized at www.mypyramid.gov.
Life Cycle Nutrition Life Cycle Nutrition
Life Cycle Changes Life Cycle Changes Nutritional needs change as a person Nutritional needs change as a person grows and develops. grows and develops. Changes generally based on growth Changes generally based on growth needs, energy needs, nutrient utilization. needs, energy needs, nutrient utilization. Nutritional assessment should be Nutritional assessment should be conducted to ascertain the nutritional conducted to ascertain the nutritional needs of the individual. needs of the individual.
Pregnancy and Lactation Pregnancy and Lactation Nutrient needs during period of intensive Nutrient needs during period of intensive growth, such as pregnancy and infancy are growth, such as pregnancy and infancy are greater than any other time in life. greater than any other time in life. Evidence has proven that optimal nutrition Evidence has proven that optimal nutrition during pregnancy reduce risk of complications during pregnancy reduce risk of complications during pregnancy and delivery. during pregnancy and delivery. Health diets and avoid alcohol and caffeine Health diets and avoid alcohol and caffeine play an important role prior to and after play an important role prior to and after pregnancy. pregnancy.
Concerns in Pregnancy Concerns in Pregnancy Weight gain: Weight gain: Discomforts and complications: Discomforts and complications: Practices to avoid: Practices to avoid: Lactation: Lactation:
Infancy Infancy
The time from birth to 1 year of age is one The time from birth to 1 year of age is one of the rapid growth and development. of the rapid growth and development. The average infant birth weight triples by The average infant birth weight triples by the first birthday. the first birthday. Nutrition is important for proper growth Nutrition is important for proper growth and development. and development.
Breast Milk: Breast Milk: Regular cow’s milk: Regular cow’s milk: Solid foods: Solid foods: Single-ingredient foods : Single-ingredient foods : Food high in iron: Food high in iron: Commercially prepared baby foods: Commercially prepared baby foods: Juice for infants younger than 6 Juice for infants younger than 6 months: months: Children having juice bottles/cups/box: Children having juice bottles/cups/box:
Childhood Childhood This is a critical time to instill good dietary habits. This is a critical time to instill good dietary habits.
– This is a critical time for instilling good dietary habits. This is a critical time for instilling good dietary habits. – At 1 year of age, appetite generally tapers off, growth slows for At 1 year of age, appetite generally tapers off, growth slows for now. now. – Children still need adequate nutrition. Children still need adequate nutrition. – The younger the child, the smaller the portions needed. The younger the child, the smaller the portions needed. – If children are offered nutritious foods in pleasant surroundings If children are offered nutritious foods in pleasant surroundings and in non-threatening ways. and in non-threatening ways. – The parents should decide which foods to serve at what time; The parents should decide which foods to serve at what time; the child should be able to decide what and how much to eat. the child should be able to decide what and how much to eat. – However this is also the time children test their independence. However this is also the time children test their independence.
Encouraging Good Dietary Habits Encouraging Good Dietary Habits Meals at the table at regular times. Meals at the table at regular times. Relaxed and enjoyable. Relaxed and enjoyable. Variety of foods. Variety of foods. Do not force children to eat or clear plates. Do not force children to eat or clear plates. Small servings. Small servings. New foods. New foods. Nutritious snacks. Nutritious snacks. Limit sweets. Limit sweets. Encourage physical activity. Encourage physical activity. Adults are to set good eating habits. Adults are to set good eating habits.
Adolescence Adolescence These years are of both physical and emotional growth. These years are of both physical and emotional growth.
Diets are often filled with kilocalorie-rich and Diets are often filled with kilocalorie-rich and nutrient-poor snack foods. nutrient-poor snack foods. Common dietary inadequacies include iron and Common dietary inadequacies include iron and calcium. calcium. Many teenagers experiment with alcohol and Many teenagers experiment with alcohol and drugs, which have detrimental effects on drugs, which have detrimental effects on nutrition. nutrition. Obesity is a common problem; weight reduction Obesity is a common problem; weight reduction diets should be attempted only under the advice diets should be attempted only under the advice of a physician and with the guidance of a of a physician and with the guidance of a dietitian. dietitian.
Adult Adult With energy, activity decreasing, weight gain With energy, activity decreasing, weight gain increasing: Nutritional needs start to decrease. increasing: Nutritional needs start to decrease.
Older Adult Considerations Older Adult Considerations Aging may affect the eating process. Aging may affect the eating process. Aroma and taste of food may change. Aroma and taste of food may change. Changes in the digestion process. Changes in the digestion process. Kilocalorie needs decrease . Kilocalorie needs decrease . Numerous medications. Numerous medications. Social and mental changes. Social and mental changes. Chronic medical conditions. Chronic medical conditions.
Malnutrition is a common problem among nursing Malnutrition is a common problem among nursing home residents and profoundly influences physical home residents and profoundly influences physical health and quality of life. health and quality of life. Residents should be offered familiar foods that taste Residents should be offered familiar foods that taste good. good. Fluids should be offered to residents at all meals and Fluids should be offered to residents at all meals and between meals. between meals. Dehydration is very common and easily corrected in Dehydration is very common and easily corrected in long term care facilities. long term care facilities. Nutritional Concerns of Adults in Long Term Care Facilities
Nurses must understand the value of mealtime as a Nurses must understand the value of mealtime as a pleasant, social experience. pleasant, social experience. Cultural and personal preferences should be considered. Cultural and personal preferences should be considered. Many residents need assistance or encouragement. Many residents need assistance or encouragement. Lack of adequate staffing play a large role in patient Lack of adequate staffing play a large role in patient nutrition. nutrition. Many patients are on restricted diets. Many patients are on restricted diets. Pressure sore due to lack of mobility, and nutrition. Pressure sore due to lack of mobility, and nutrition. Nutrient-Drug interactions. Nutrient-Drug interactions.
Caffeine Caffeine Caffeine: Caffeine: Drug Drug Central nervous system stimulant and diuretic. Central nervous system stimulant and diuretic. Nervousness Nervousness Irritability Irritability Anxiety Anxiety Insomnia Insomnia Heart arrhythmias Heart arrhythmias Palpitations Palpitations See Caffeine Content of Selected Beverages and Foods. See Caffeine Content of Selected Beverages and Foods.
Common Medications and Their Effect on Common Medications and Their Effect on Nutrition Nutrition Antacids. Antacids. Antibiotics. Antibiotics. Anticoagulants. Anticoagulants. Aspirin. Aspirin. Diuretics. Diuretics. Laxatives. Laxatives.
Medical Nutrition Therapy Medical Nutrition Therapy and Therapeutic Diets and Therapeutic Diets These diets are specific nutrition as needed to treat an illness, injury or These diets are specific nutrition as needed to treat an illness, injury or condition. condition.
Purpose of Diet Therapy Purpose of Diet Therapy The dietary prescription is written for one or The dietary prescription is written for one or more of the following purposes: more of the following purposes: Provide the client with nutrients needed for Provide the client with nutrients needed for maintenance or growth. maintenance or growth. Prepare a client for diagnostic tests. Prepare a client for diagnostic tests. Treat the client with a disease or condition. Treat the client with a disease or condition.
DIET THERAPY DIET THERAPY The treatment of a disease or The treatment of a disease or disorder with a special diet. disorder with a special diet. A client must not be given A client must not be given anything to eat or drink without anything to eat or drink without an order. an order.
The Vegetarian Diet The Vegetarian Diet Lacto-ovo vegetarians–use dairy Lacto-ovo vegetarians–use dairy products and eggs but no meat, products and eggs but no meat, poultry, or fish. poultry, or fish. Lacto vegetarians–use dairy products Lacto vegetarians–use dairy products but no meat, poultry, or eggs. but no meat, poultry, or eggs. Vegans–avoid all animal foods. Vegans–avoid all animal foods.
Factors Influencing Diet Factors Influencing Diet Culture Culture Religion Religion Socioeconomics Socioeconomics Fads Fads Superstitions Superstitions
BASIC BASIC NUTRITIONAL ASSESSMENT NUTRITIONAL ASSESSMENT Nutritional status Nutritional status Height and weight Height and weight Meal and snack pattern Meal and snack pattern Food allergies Food allergies Physical activity Physical activity Cultural, ethnic, and family influences Cultural, ethnic, and family influences Use of vitamin/mineral supplements Use of vitamin/mineral supplements
NUTRITION AND HEALTH NUTRITION AND HEALTH Primary nutritional disease–occurs Primary nutritional disease–occurs when nutrition is the cause of the when nutrition is the cause of the disease. disease. Secondary nutritional disease– Secondary nutritional disease– occurs as a complication of occurs as a complication of another disease or condition. another disease or condition.
WEIGHT MANAGEMENT WEIGHT MANAGEMENT Based on relationship between Based on relationship between intake and use of kcal. intake and use of kcal. Overweight: 11%–19% above Overweight: 11%–19% above Obesity: 20% or more above Obesity: 20% or more above Underweight: 10%–15% under Underweight: 10%–15% under
FOOD LABELING FOOD LABELING Required on virtually all retail food Required on virtually all retail food products. products. Labels must follow the approved uniform Labels must follow the approved uniform format and use standard serving sizes format and use standard serving sizes and household measurements. and household measurements.
FOOD QUALITY AND SAFETY FOOD QUALITY AND SAFETY Proper storage, preparation, Proper storage, preparation, sanitation, and cooking are sanitation, and cooking are necessary to help prevent or reduce necessary to help prevent or reduce the risk of food-borne illnesses. the risk of food-borne illnesses.
Consistency, Texture, and Frequency Consistency, Texture, and Frequency Modifications Modifications Liquid Diets: Liquid Diets: Clear Liquids Clear Liquids Full Liquids Full Liquids Soft and Low-Residue Diets. Soft and Low-Residue Diets. High Fiber Diets. High Fiber Diets. Meal Frequency Modification. Meal Frequency Modification.
Kilocalorie Modifications Kilocalorie Modifications Basal Metabolic Rate (BMR). Basal Metabolic Rate (BMR). High-Kilocalorie and High Protein Diets. High-Kilocalorie and High Protein Diets. Anorexia. Anorexia. Kilocalorie-Controlled and Low-Kilocalorie Diets. Kilocalorie-Controlled and Low-Kilocalorie Diets. Obesity Obesity Measurements of Obesity Measurements of Obesity BMI BMI Body Composition Body Composition Waist circumference Waist circumference Treatment of Obesity Treatment of Obesity
Eating Disorders Eating Disorders Anorexia Nervosa: Anorexia Nervosa: Self-imposed starvation. Self-imposed starvation. Individuals have an intense drive for thinness, Individuals have an intense drive for thinness, an intense fear of gaining weight or becoming an intense fear of gaining weight or becoming fat, and a distorted body image. fat, and a distorted body image. Bulimia Nervosa: Bulimia Nervosa: Periods of binge eating followed by purging Periods of binge eating followed by purging (self-induced vomiting, emetics, laxatives, (self-induced vomiting, emetics, laxatives, enemas, or diuretics). enemas, or diuretics). Often normal weight or overweight. Often normal weight or overweight. Binge / Purge: Binge / Purge:
Comparison of Eating Disorders Comparison of Eating Disorders Diagnoses Diagnoses Body weight and other physical Body weight and other physical indicators. indicators. Eating behaviors. Eating behaviors. Compensatory behaviors (purging). Compensatory behaviors (purging). Psychologic indicators. Psychologic indicators.
Carbohydrate-Modified Diets Carbohydrate-Modified Diets Diabetes Mellitus: Diabetes Mellitus: A disease in which the body does not produce or A disease in which the body does not produce or properly properly use insulin. use insulin. Insulin convert sugar, starches, and other food into Insulin convert sugar, starches, and other food into energy needed for daily life. energy needed for daily life. Two major types of diabetes: Two major types of diabetes: Type 1 Type 1 Type 2 Type 2
Primary goals for medical nutrition therapy: Primary goals for medical nutrition therapy: – Improve metabolic control by achieving Improve metabolic control by achieving and maintaining optimal blood glucose. and maintaining optimal blood glucose. – Provide adequate energy for maintenance Provide adequate energy for maintenance of a reasonable body weight. of a reasonable body weight. – Prevent acute and chronic complications Prevent acute and chronic complications of diabetes. of diabetes. – Improve overall health through optimal Improve overall health through optimal nutrition nutrition
Carbohydrate intake should be monitored and Carbohydrate intake should be monitored and controlled. controlled. Diabetic diet tools: Diabetic diet tools: –Exchange lists for meal planning Exchange lists for meal planning –Carbohydrate counting Carbohydrate counting Other nutritional considerations: Other nutritional considerations: –Hypoglycemia: consumption of inadequate Hypoglycemia: consumption of inadequate carbohydrates causes the blood sugar to carbohydrates causes the blood sugar to drop. drop.
Carbohydrate-Modified Diets Carbohydrate-Modified Diets (continued) (continued) – Dumping Syndrome: Dumping Syndrome: It may occur after surgery in which a portion It may occur after surgery in which a portion or all of the stomach is removed. or all of the stomach is removed. – Lactose Intolerance: Lactose Intolerance: Intolerance occurs as a result of a lack of the Intolerance occurs as a result of a lack of the digestive enzyme lactase. digestive enzyme lactase.
Special Diets Special Diets Low-residue diet Low-residue diet High-fiber diet High-fiber diet Liberal bland diet Liberal bland diet Fat-controlled diet Fat-controlled diet Sodium-restricted diet Sodium-restricted diet
Fat Modified Diet Fat Modified Diet These diets are beneficial in reducing the risk of atherosclerosis. These diets are beneficial in reducing the risk of atherosclerosis. Lowering dietary fat may assist in disease treatment and control. Lowering dietary fat may assist in disease treatment and control.
Fat-Controlled Diets: Fat-Controlled Diets: Limits total fat, saturated fat, and Limits total fat, saturated fat, and trans-fatty acids. trans-fatty acids. Low-Fat Diets: Low-Fat Diets: All fats limited, regardless of saturation. All fats limited, regardless of saturation.
Lowering Fat/Saturated Fat/Trans Fatty Lowering Fat/Saturated Fat/Trans Fatty Acids/Cholesterol Acids/Cholesterol Food Groups: Food Groups: Choose: Choose: Go Easy on: Go Easy on:
Protein/Electrolyte Protein/Electrolyte and and Fluid-Modified Diets Fluid-Modified Diets Increased protein facilitate healing. Increased protein facilitate healing. Defects in protein is seen in liver/renal disease. Defects in protein is seen in liver/renal disease.
Sodium-Restricted Diets: Sodium-Restricted Diets: pg 649 box 21-9 pg 649 box 21-9 Potassium-Modified Diets: Potassium-Modified Diets: Fluid-Modified Diets: Fluid-Modified Diets: Fluid Restrictions Fluid Restrictions Fluid Increase Fluid Increase
Patient Teaching Patient Teaching Fluid restrictions: Fluid restrictions: Explain the rationale. Explain the rationale. Indicated if restriction is temporary or permanent. Indicated if restriction is temporary or permanent. Educate, discuss different sources of water. Educate, discuss different sources of water. Teach how to count fluids. Teach how to count fluids. Show the patient how much fluid is allowed. Show the patient how much fluid is allowed. Suggest ways to alleviate thirst without drinking. Suggest ways to alleviate thirst without drinking. Discuss the consequences of over consumption of fluids. Discuss the consequences of over consumption of fluids.
Nutritional Support Nutritional Support
Nutritional Support Nutritional Support Enteral nutrition–includes both the Enteral nutrition–includes both the ingestion of food orally and the delivery of ingestion of food orally and the delivery of nutrients through a GI tube. nutrients through a GI tube. Parenteral nutrition–the infusion of a Parenteral nutrition–the infusion of a solution of nutrients directly into a vein to solution of nutrients directly into a vein to meet the client’s daily requirements. meet the client’s daily requirements.
Tube Feedings Tube Feedings – Administration of nutritionally balanced liquefied Administration of nutritionally balanced liquefied foods or formula though a tube inserted into the foods or formula though a tube inserted into the stomach, duodenum, or jejunum by way of a stomach, duodenum, or jejunum by way of a nasogastric tube or a feeding ostomy. nasogastric tube or a feeding ostomy. – Indicated when a patient is unable to chew or Indicated when a patient is unable to chew or swallow, has no appetite, or refuses to eat. swallow, has no appetite, or refuses to eat. – Tube feeding used only when all or at least part Tube feeding used only when all or at least part of the GI tract is functioning. of the GI tract is functioning. – Feeding given continuously or intermittently. Feeding given continuously or intermittently.
Figure 21-7 Figure 21-7 Tube feeding sites. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Nasogastric Tube Feedings Nasogastric Tube Feedings Checking for placement of a feeding tube before Checking for placement of a feeding tube before administering medication or tube feeding is critical administering medication or tube feeding is critical to safe patient care. to safe patient care. Tube may be accidentally placed in the lung, Tube may be accidentally placed in the lung, esophagus, or even the stomach when it should esophagus, or even the stomach when it should be in the small bowel. be in the small bowel. To test, use chest x-ray, test pH of aspirated fluid, To test, use chest x-ray, test pH of aspirated fluid, or use auscultatory method. or use auscultatory method.
Administering Administering Nasogastric Tube Nasogastric Tube Feedings Feedings
Skill 21-1: Step 10a(1) Skill 21-1: Step 10a(1) Administering nasogastric tube feedings. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Skill 21-1: Step 10a(2) Skill 21-1: Step 10a(2) Administering nasogastric tube feedings. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Skill 21-1: Step 10b Skill 21-1: Step 10b Administering nasogastric tube feedings. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing [6th ed.]. St. Louis: Mosby.)
Administering nasogastric tube feedings. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Administering nasogastric tube feedings. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Parenteral Nutrition Support Parenteral Nutrition Support – Parenteral nutrition ( Parenteral nutrition (hyperalimentation hyperalimentation): ): Intravenous feedings. Intravenous feedings. May be administered through peripheral veins. May be administered through peripheral veins. – Total parenteral nutrition (TPN): Total parenteral nutrition (TPN): Administration of hypertonic solution into a large Administration of hypertonic solution into a large central vein. central vein. Composed of glucose, amino acids, vitamins, minerals, Composed of glucose, amino acids, vitamins, minerals, and electrolytes; fats also given as a supplement to the and electrolytes; fats also given as a supplement to the main formula. main formula. Indicated for the patient with a nonfunctioning or Indicated for the patient with a nonfunctioning or dysfunctional GI tract. dysfunctional GI tract.
Figure 21-8 Figure 21-8 Central venous catheter placement during administration of parenteral nutrition. (Courtesy of Rolin Graphics.)
Nursing Assessment Nursing Assessment Must be performed in a logical fashion Must be performed in a logical fashion and should include a nutritional and should include a nutritional history, physical examination, and the history, physical examination, and the results of laboratory tests. results of laboratory tests.
Nursing Diagnosis Nursing Diagnosis Imbalanced nutrition: Imbalanced nutrition: – Less than body requirements Less than body requirements – More than body requirements More than body requirements Risk for imbalanced nutrition: more than Risk for imbalanced nutrition: more than body requirements body requirements Disturbed body image Disturbed body image Ineffective breastfeeding Ineffective breastfeeding
Impaired dentition Impaired dentition Deficient knowledge (specify) Deficient knowledge (specify) Impaired oral mucous membrane Impaired oral mucous membrane Pain Pain Feeding self-care deficit Feeding self-care deficit Chronic low self-esteem Chronic low self-esteem Risk for impaired skin integrity Risk for impaired skin integrity
Planning / Outcome Planning / Outcome A plan should be formulated by the A plan should be formulated by the nurse and client to achieve mutually nurse and client to achieve mutually agreed-upon goals. agreed-upon goals. The plan is individualized to meet The plan is individualized to meet the client’s specific needs. the client’s specific needs.
Implementation Implementation Interventions to accomplish the goals Interventions to accomplish the goals may include diet therapy, assistance may include diet therapy, assistance with meals, weight and intake with meals, weight and intake monitoring, and nutritional support. monitoring, and nutritional support.
Questions ? Questions ?

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White-updated-Basic-Nut.-chap-166666.ppt

  • 1.
    Basic Nutrition and BasicNutrition and Nutritional Therapy Nutritional Therapy Foundations of Foundations of Nursing Nursing Christensen Christensen Kockrow Kockrow Mosby 5 Mosby 5th th edition edition Sharon Kinley-Schwing BSN Pacific College 2006
  • 2.
    Prevention = nutritionone of the most important parts of health Prevention = nutrition one of the most important parts of health care. care. Nutrition is the total of all processes involved in the taking in and Nutrition is the total of all processes involved in the taking in and utilization of food substances for proper growth, functioning, and utilization of food substances for proper growth, functioning, and maintenance of health. maintenance of health. Nutrition plays a role directly or indirectly in all body processes, and Nutrition plays a role directly or indirectly in all body processes, and disease states. disease states. Proper nutrition may help prevent or delay onset of many diseases. Proper nutrition may help prevent or delay onset of many diseases. Nutrition is the most over looked part of healthy living. Nutrition is the most over looked part of healthy living.
  • 3.
    Role of theNurse in Promotion Nutrition Role of the Nurse in Promotion Nutrition The nurse can promote good nutrition by: The nurse can promote good nutrition by: – Helping the patient understand the importance of the diet and Helping the patient understand the importance of the diet and encouraging dietary compliance. encouraging dietary compliance. – Serving meal trays to patients in a prompt and positive Serving meal trays to patients in a prompt and positive manner. manner. – Assisting some patients with the eating process. Assisting some patients with the eating process. – Taking and recording patient weight. Taking and recording patient weight. – Recording patient intake. Recording patient intake. – Observing clinical signs of poor nutrition and reporting them. Observing clinical signs of poor nutrition and reporting them. – Serving as a communication link. Serving as a communication link. – Nurse can apply nutrition to their personal lives, what a Nurse can apply nutrition to their personal lives, what a better reason to understand nutrition for your own health. better reason to understand nutrition for your own health.
  • 4.
    NUTRITION NUTRITION All of theprocesses involved in consuming All of the processes involved in consuming and utilizing food for energy, and utilizing food for energy, maintenance, and growth. maintenance, and growth. These processes are ingestion, digestion, These processes are ingestion, digestion, absorption, metabolism, and excretion. absorption, metabolism, and excretion.
  • 5.
    INGESTION INGESTION The taking offood into the digestive The taking of food into the digestive tract, generally through the mouth. tract, generally through the mouth. In special circumstances, ingestion In special circumstances, ingestion occurs directly into the stomach, occurs directly into the stomach, through a feeding tube. through a feeding tube.
  • 6.
    DIGESTION DIGESTION Mechanical and chemicalprocesses Mechanical and chemical processes converting nutrients to a physically converting nutrients to a physically absorbable state: absorbable state: – Mastication–chewing Mastication–chewing – Deglutition–swallowing Deglutition–swallowing – Peristalsis–rhythmic, coordinated, serial Peristalsis–rhythmic, coordinated, serial contractions of smooth muscles of GI tract contractions of smooth muscles of GI tract
  • 8.
    ABSORPTION ABSORPTION The process wherebythe end products of The process whereby the end products of digestion pass through the epithelial digestion pass through the epithelial membranes in small and large intestines membranes in small and large intestines and into blood or lymph systems. and into blood or lymph systems. Villi–small finger-like projections that line Villi–small finger-like projections that line the small intestine. Most nutrients are the small intestine. Most nutrients are absorbed directly through the villi. absorbed directly through the villi.
  • 9.
    METABOLISM METABOLISM The conversion ofnutrients into energy. The conversion of nutrients into energy. Anabolism–the constructive process of metabolism, Anabolism–the constructive process of metabolism, requires energy. requires energy. Catabolism–the destructive process of metabolism, Catabolism–the destructive process of metabolism, releases energy. releases energy. Basal metabolism–the energy needed to maintain Basal metabolism–the energy needed to maintain essential physiologic functions. essential physiologic functions.
  • 10.
    EXCRETION EXCRETION The process ofeliminating or The process of eliminating or removing waste products from removing waste products from the body. the body.
  • 11.
    NUTRIENTS NUTRIENTS Water Water Carbohydrates Carbohydrates Fats Fats Proteins Proteins Vitamins Vitamins Minerals Minerals The body musthave six types of nutrients to The body must have six types of nutrients to function efficiently and effectively: function efficiently and effectively:
  • 12.
    Dietary Guidelines forAmericans: Dietary Guidelines for Americans: These guidelines form the foundation of U.S. federal These guidelines form the foundation of U.S. federal nutrition policy and directly affect federal nutrition nutrition policy and directly affect federal nutrition programs such as food stamps, school breakfast and programs such as food stamps, school breakfast and lunch programs, and the Special Supplemental lunch programs, and the Special Supplemental Program for Women, Infants, and Children (WIC). Program for Women, Infants, and Children (WIC). These guidelines have been developed to address the These guidelines have been developed to address the importance of adequate nutrition, as well as the importance of adequate nutrition, as well as the prevention of over nutrition and disease. prevention of over nutrition and disease. Dietary Reference Intakes: Dietary Reference Intakes: This is a set of nutrient-based values that can be used for This is a set of nutrient-based values that can be used for both assessing and planning diets. both assessing and planning diets. They form the basis for daily values used in the They form the basis for daily values used in the Nutrition Facts labels on foods. Nutrition Facts labels on foods. The DRIs are intended to help individuals optimize The DRIs are intended to help individuals optimize their health, prevent disease, and avoid consuming their health, prevent disease, and avoid consuming too much of a nutrient. too much of a nutrient.
  • 13.
    Essential Nutrients Essential Nutrients –Basic Functions: Basic Functions: Essential nutrients are those that our bodies cannot make in Essential nutrients are those that our bodies cannot make in amounts necessary for good health. amounts necessary for good health. The six classes of essential nutrients are carbohydrates, The six classes of essential nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water. fats, proteins, vitamins, minerals, and water. Provide energy Provide energy – Carbohydrates and proteins: 4 kcal/g Carbohydrates and proteins: 4 kcal/g – Fat: 9 kcal/g Fat: 9 kcal/g Build and repair tissue Build and repair tissue – Protein, calcium, phosphorus, iron, and fat Protein, calcium, phosphorus, iron, and fat Regulate body processes Regulate body processes – Metabolism: the combination of all chemical processes Metabolism: the combination of all chemical processes that take place in living organisms that take place in living organisms
  • 14.
    CARBOHYDRATES CARBOHYDRATES Made of theelements carbon, hydrogen, Made of the elements carbon, hydrogen, and oxygen (CHO) and oxygen (CHO) Constitute the chief source of energy for Constitute the chief source of energy for all body functions. all body functions. Requirements are 50–60% of total kcal Requirements are 50–60% of total kcal intake per day. intake per day.
  • 15.
    Carbohydrates Carbohydrates Carbohydrates: Carbohydrates: Simple Carbohydrates: Simple Carbohydrates: ComplexCarbohydrates: Complex Carbohydrates: Digestion and Metabolism of Carbohydrates: Digestion and Metabolism of Carbohydrates:
  • 16.
    CARBOHYDRATE FUNCTIONS CARBOHYDRATE FUNCTIONS Primarysource of energy for the body. Primary source of energy for the body. About half-day supply stored in liver and About half-day supply stored in liver and muscles for use as needed. muscles for use as needed. Spares proteins from being used for energy. Spares proteins from being used for energy. Needed to oxidize fats and for synthesis of fatty Needed to oxidize fats and for synthesis of fatty acids and amino acids. acids and amino acids.
  • 17.
    Carbohydrate Absorption &Storage Carbohydrate Absorption & Storage Digestion begins in mouth, little takes place in Digestion begins in mouth, little takes place in the stomach, is completed in the small the stomach, is completed in the small intestine. intestine. Leave no waste for kidneys to eliminate. Leave no waste for kidneys to eliminate. Absorption takes place in the villi. Absorption takes place in the villi. Excess converted to glycogen and stored in Excess converted to glycogen and stored in the liver or stored as fat. the liver or stored as fat.
  • 18.
    DEFICIENCY AND EXCESS DEFICIENCYAND EXCESS Mild deficiency can cause weight loss Mild deficiency can cause weight loss and fatigue. and fatigue. Serious deficiency can cause ketosis. Serious deficiency can cause ketosis. Excess can cause obesity, tooth Excess can cause obesity, tooth decay, irritate the lining of the decay, irritate the lining of the stomach, or flatulence. stomach, or flatulence.
  • 19.
    FATS FATS Most concentrated energysource in diet. Most concentrated energy source in diet. Provides 9 kcal per gram. Provides 9 kcal per gram. Also known as lipids. Also known as lipids. Composed of carbon, hydrogen, and less oxygen Composed of carbon, hydrogen, and less oxygen than carbohydrates. than carbohydrates. Recommended: no more than 25–30% of daily Recommended: no more than 25–30% of daily intake. intake.
  • 20.
    Fats (Lipids) Fats (Lipids) Lipids: Lipids: Saturatedfatty acids: Saturated fatty acids: Unsaturated fatty acids: Unsaturated fatty acids: Trans Fatty Acids: Trans Fatty Acids: Cholesterol: Cholesterol: Digestion and Metabolism of fat: Digestion and Metabolism of fat:
  • 21.
    Summary of FattyAcid Classification Summary of Fatty Acid Classification Saturated Saturated Monounsaturated: Monounsaturated: Polyunsaturated: Polyunsaturated: Trans: Trans:
  • 22.
    Classification of LDL,Total HDL, Cholesterol Classification of LDL, Total HDL, Cholesterol LDL Cholesterol: LDL Cholesterol: Total Cholesterol: Total Cholesterol: HDL Cholesterol: HDL Cholesterol:
  • 23.
    Functions of Fat Functionsof Fat Provides concentrated source of energy. Provides concentrated source of energy. Needed to absorb fat-soluble vitamins. Needed to absorb fat-soluble vitamins. Major component of cell membranes and myelin Major component of cell membranes and myelin sheaths. sheaths. Improves flavor, delays emptying time. Improves flavor, delays emptying time. Protects and helps hold organs in place. Protects and helps hold organs in place. Insulates the body. Insulates the body.
  • 24.
    CLASSIFICATION CLASSIFICATION Triglycerides (true fats)are composed of one Triglycerides (true fats) are composed of one glycerol molecule attached to three fatty- glycerol molecule attached to three fatty- acid molecules. acid molecules. Phospholipids (lipoids) are composed of Phospholipids (lipoids) are composed of glycerol, fatty acids, and phosphorus. glycerol, fatty acids, and phosphorus. Cholesterol (sterol) liver produces over 1000 Cholesterol (sterol) liver produces over 1000 mg every day. mg every day.
  • 25.
    Absorption and Storage Absorptionand Storage No breakdown occurs in the mouth, very little No breakdown occurs in the mouth, very little digestion occurs in the stomach. digestion occurs in the stomach. Digestion begins in the small intestine. Digestion begins in the small intestine. Final products of fat digestion are fatty acids and Final products of fat digestion are fatty acids and glycerol. glycerol. 95% absorbed in small intestine. 95% absorbed in small intestine. Excess fats stored as adipose tissue. Excess fats stored as adipose tissue.
  • 26.
    Deficiency and Excess Deficiencyand Excess Deficiency occurs when fats provide less Deficiency occurs when fats provide less than 10% of the total daily kcal than 10% of the total daily kcal requirement. requirement. May result in eczema, retarded growth, May result in eczema, retarded growth, weight loss. weight loss. Excess can lead to overweight and heart Excess can lead to overweight and heart disease. disease.
  • 27.
    Sources of Fat Sourcesof Fat Animal fats–lard, butter, milk, cream, Animal fats–lard, butter, milk, cream, egg yolks, meat, poultry, and fish. egg yolks, meat, poultry, and fish. Plant fats–corn oil, safflower oil, olive Plant fats–corn oil, safflower oil, olive oil, cottonseed oil, peanut oil, palm oil, oil, cottonseed oil, peanut oil, palm oil, and coconut oil, nuts, and avocado. and coconut oil, nuts, and avocado.
  • 28.
    Protein Protein Amino Acids: Amino Acids: Completeproteins: Complete proteins: Incomplete proteins: Incomplete proteins: Vegetarian diets: Vegetarian diets: Digestion and Metabolism of Protein: Digestion and Metabolism of Protein: Protein-Kilocalorie malnutrition: Protein-Kilocalorie malnutrition:
  • 29.
    Proteins Proteins Made of carbon,hydrogen, oxygen, and Made of carbon, hydrogen, oxygen, and nitrogen (CHON). nitrogen (CHON). The only nutrient that can build, repair, and The only nutrient that can build, repair, and maintain body tissues. maintain body tissues. Daily requirement for average adults is 0.8g Daily requirement for average adults is 0.8g of protein for each kilogram of body weight. of protein for each kilogram of body weight.
  • 30.
    Functions Of Proteins FunctionsOf Proteins Provide amino acids, needed to build, repair, and Provide amino acids, needed to build, repair, and maintain body tissues. maintain body tissues. Assist in regulating fluid balance. Assist in regulating fluid balance. Vital part of enzymes, hormones, blood plasma. Vital part of enzymes, hormones, blood plasma. Used to build antibodies. Used to build antibodies. Can be converted to glucose, for energy. Can be converted to glucose, for energy.
  • 31.
    Protein Digestion andabsorption Protein Digestion and absorption Begins in the stomach. Begins in the stomach. Most digestion takes place in small intestine. Most digestion takes place in small intestine. End product is amino acids, absorbed into End product is amino acids, absorbed into the blood by the villi in the small intestine. the blood by the villi in the small intestine. Excess amino acids are converted to glucose, Excess amino acids are converted to glucose, glycogen, or fat for storage. glycogen, or fat for storage.
  • 32.
    Sign of Deficiencyand Excess Sign of Deficiency and Excess Muscle wasting. Muscle wasting. Edema. Edema. Lethargy and depression. Lethargy and depression. Marasmus and Kwashiorkor. Marasmus and Kwashiorkor. Excess can contribute to heart disease, and may be Excess can contribute to heart disease, and may be linked to colon cancer, osteoporosis, and kidney linked to colon cancer, osteoporosis, and kidney damage. damage.
  • 33.
    Vitamins and Minerals Vitaminsand Minerals They are needed in small amounts; toxicity may occur They are needed in small amounts; toxicity may occur with over consumption. with over consumption. They are best received from a balanced, varied diet. They are best received from a balanced, varied diet. Vitamins can be destroyed by heat, light, and exposure Vitamins can be destroyed by heat, light, and exposure to air. to air. Minerals cannot be destroyed because they are single Minerals cannot be destroyed because they are single elements rather than compounds. elements rather than compounds. Both vitamins and minerals can be lost when foods are Both vitamins and minerals can be lost when foods are cooked in water. cooked in water.
  • 34.
    VITAMINS VITAMINS Organic compounds essentialto life and health. Organic compounds essential to life and health. Regulate body processes, needed in very small Regulate body processes, needed in very small amounts. amounts. No fuel value but required for metabolism of No fuel value but required for metabolism of fats, carbohydrates, proteins. fats, carbohydrates, proteins. Functions are unique to each vitamin. Functions are unique to each vitamin.
  • 35.
    –Fat soluble: Fat soluble: A,D, E, and K. A, D, E, and K. Usually carried in the fatty Usually carried in the fatty portion of food. portion of food. Can be stored by the body. Can be stored by the body. –Water soluble: Water soluble: B vitamins and C. B vitamins and C. Not stored in the body; excesses Not stored in the body; excesses excreted in the urine. excreted in the urine.
  • 36.
    Digestion of Vits Digestionof Vits Vitamins do not require digestion. Vitamins do not require digestion. Fat-soluble vitamins are absorbed into the Fat-soluble vitamins are absorbed into the lymphatic system, excesses are stored in lymphatic system, excesses are stored in the liver and adipose tissue. the liver and adipose tissue. Water-soluble vitamins are absorbed Water-soluble vitamins are absorbed directly into the circulatory system, and directly into the circulatory system, and excesses are excreted in urine. excesses are excreted in urine.
  • 37.
    Deficiency/ Excess Deficiency/ Excess Vitamindeficiencies can occur and Vitamin deficiencies can occur and result in disease. result in disease. Vitamins consumed in excess Vitamins consumed in excess amounts can be toxic to the body. amounts can be toxic to the body.
  • 38.
    Minerals Minerals Inorganic elements thathelp regulate body Inorganic elements that help regulate body processes and /or serve as structural processes and /or serve as structural components of the body. components of the body. Major minerals–more than 100 mg/day. Major minerals–more than 100 mg/day. Trace minerals–less than 100 mg/day. Trace minerals–less than 100 mg/day. Functions are unique to each individual Functions are unique to each individual mineral. mineral.
  • 39.
    Classification and Sources Classificationand Sources Classified as major minerals or trace minerals. Classified as major minerals or trace minerals. Found in water and in unprocessed foods. Found in water and in unprocessed foods. Some foods are enriched—some vitamins are Some foods are enriched—some vitamins are added to them. added to them. Supplements may be needed during growth Supplements may be needed during growth periods, some clinical situations. periods, some clinical situations.
  • 40.
    Digestion Digestion The amount ofa mineral absorbed by The amount of a mineral absorbed by the body is influenced by: the body is influenced by: Type of food Type of food Need of body Need of body Health of absorbing tissue Health of absorbing tissue
  • 41.
    Deficiency and Excess Deficiencyand Excess Deficiency signs unique to each mineral. Deficiency signs unique to each mineral. Excesses can lead to toxicity. Excesses can lead to toxicity. Concentrated forms of minerals should Concentrated forms of minerals should be used only on advice of a physician. be used only on advice of a physician. Excesses can cause hair loss, changes Excesses can cause hair loss, changes in the blood, hormones, bones, muscles, and in the blood, hormones, bones, muscles, and nearly all tissues. nearly all tissues.
  • 42.
    Vitamins Vitamins Antioxidant vitamins: Antioxidant vitamins: VitaminA: Vitamin A: Vitamin C: Vitamin C: Vitamin D: Vitamin D: Vitamin E: Vitamin E:
  • 43.
    Vitamin K: Vitamin K: FolateAcid: Folate Acid: Thiamine: Thiamine: Vitamin B 12: Vitamin B 12: Riboflavin: Riboflavin: Niacin: Niacin:
  • 44.
    Vitamin B6: Vitamin B6: Biotin: Biotin: Choline: Choline: PantothenicAcid: Pantothenic Acid: Vitamin C: Vitamin C:
  • 45.
  • 46.
  • 47.
  • 48.
    WATER ! WATER ! Nutrientmost vital to life. Nutrient most vital to life. Makes up approximately 60% of adult body Makes up approximately 60% of adult body weight and 80% of infant weight. weight and 80% of infant weight. Provides form and structure to body tissues. Provides form and structure to body tissues.
  • 50.
    Acts as asolvent; necessary for most chemical Acts as a solvent; necessary for most chemical processes. processes. Transports nutrients and other substances. Transports nutrients and other substances. Lubricates and protects moving parts of the Lubricates and protects moving parts of the body. body. Lubricates food and aids in digestion. Lubricates food and aids in digestion. Regulates body temperature Regulates body temperature
  • 51.
    SOURCES OF WATERFOR THE BODY SOURCES OF WATER FOR THE BODY Liquids consumed, including water, coffee, Liquids consumed, including water, coffee, juice, tea, milk and soft drinks. juice, tea, milk and soft drinks. Foods consumed, especially vegetables and Foods consumed, especially vegetables and fruits. fruits. Metabolism, which produces water when Metabolism, which produces water when oxidization occurs. oxidization occurs.
  • 52.
    WATER DIGESTION/ ABSORPTION,/STORAGE WATERDIGESTION/ ABSORPTION,/STORAGE Water is absorbed, not digested. Water is absorbed, not digested. It is not stored and is excreted daily. It is not stored and is excreted daily. Sensible loss–aware of loss of water. Sensible loss–aware of loss of water. Insensible loss–not aware of loss of water. Insensible loss–not aware of loss of water. Urine, feces, perspiration, and respiration are the four Urine, feces, perspiration, and respiration are the four ways the body loses water. ways the body loses water.
  • 53.
    SIGNS OF SIGNS OF Dehydration: Dehydration: –Deficiency of water, can cause death. Deficiency of water, can cause death. – Occurs from profuse sweating, vomiting, Occurs from profuse sweating, vomiting, diarrhea, hemorrhage, wound drainage, diarrhea, hemorrhage, wound drainage, fever, and edema. fever, and edema. Positive water balance when more water Positive water balance when more water taken in than used or excreted. taken in than used or excreted.
  • 54.
    Selected Foods withVit. C: Selected Foods with Vit. C: Selected Foods with Vit. D: Selected Foods with Vit. D: Factors that affect Calcium Absorption and Factors that affect Calcium Absorption and Excretion: Excretion: Factors that affect iron Absorption: Factors that affect iron Absorption:
  • 55.
  • 56.
    Diet Planning Guides DietPlanning Guides A number of guidelines have been established in A number of guidelines have been established in the US to help guide Americans in healthy and the US to help guide Americans in healthy and balanced eating. balanced eating. – My Pyramid: My Pyramid: Bread, cereal, rice, and pasta group. Bread, cereal, rice, and pasta group. Vegetable group. Vegetable group. Fruit group. Fruit group. Milk, yogurt, and cheese group. Milk, yogurt, and cheese group. Meat, poultry, fish, dried beans, eggs, and Meat, poultry, fish, dried beans, eggs, and nuts group. nuts group. Fats, oils, and sweets. Fats, oils, and sweets.
  • 57.
    MyPyramid, a personalized guide todaily food choices and number of servings. (From US Department of Agriculture, Washington, DC, 2005, US Government Printing Office.)
  • 58.
    MyPyramid MyPyramid U.S. Department ofAgricultures, Pyramid symbolizes a personalized U.S. Department of Agricultures, Pyramid symbolizes a personalized approach to health eating and physical activity. approach to health eating and physical activity. MyPyramid emphasizes key concepts in physical activity and eating. MyPyramid emphasizes key concepts in physical activity and eating. Moderation is represented by the narrowing of each food group. Moderation is represented by the narrowing of each food group. The wider base stands for food with little or no solid fats or added The wider base stands for food with little or no solid fats or added sugars. sugars. The Narrower top area is food with more added sugars and solid The Narrower top area is food with more added sugars and solid fats. fats. Varity and proportionality is shown by different widths of food groups. Varity and proportionality is shown by different widths of food groups. This pyramid can be personalized at www.mypyramid.gov. This pyramid can be personalized at www.mypyramid.gov.
  • 59.
  • 60.
    Life Cycle Changes LifeCycle Changes Nutritional needs change as a person Nutritional needs change as a person grows and develops. grows and develops. Changes generally based on growth Changes generally based on growth needs, energy needs, nutrient utilization. needs, energy needs, nutrient utilization. Nutritional assessment should be Nutritional assessment should be conducted to ascertain the nutritional conducted to ascertain the nutritional needs of the individual. needs of the individual.
  • 61.
    Pregnancy and Lactation Pregnancyand Lactation Nutrient needs during period of intensive Nutrient needs during period of intensive growth, such as pregnancy and infancy are growth, such as pregnancy and infancy are greater than any other time in life. greater than any other time in life. Evidence has proven that optimal nutrition Evidence has proven that optimal nutrition during pregnancy reduce risk of complications during pregnancy reduce risk of complications during pregnancy and delivery. during pregnancy and delivery. Health diets and avoid alcohol and caffeine Health diets and avoid alcohol and caffeine play an important role prior to and after play an important role prior to and after pregnancy. pregnancy.
  • 62.
    Concerns in Pregnancy Concernsin Pregnancy Weight gain: Weight gain: Discomforts and complications: Discomforts and complications: Practices to avoid: Practices to avoid: Lactation: Lactation:
  • 63.
  • 64.
    The time frombirth to 1 year of age is one The time from birth to 1 year of age is one of the rapid growth and development. of the rapid growth and development. The average infant birth weight triples by The average infant birth weight triples by the first birthday. the first birthday. Nutrition is important for proper growth Nutrition is important for proper growth and development. and development.
  • 65.
    Breast Milk: Breast Milk: Regularcow’s milk: Regular cow’s milk: Solid foods: Solid foods: Single-ingredient foods : Single-ingredient foods : Food high in iron: Food high in iron: Commercially prepared baby foods: Commercially prepared baby foods: Juice for infants younger than 6 Juice for infants younger than 6 months: months: Children having juice bottles/cups/box: Children having juice bottles/cups/box:
  • 66.
    Childhood Childhood This is acritical time to instill good dietary habits. This is a critical time to instill good dietary habits.
  • 67.
    – This isa critical time for instilling good dietary habits. This is a critical time for instilling good dietary habits. – At 1 year of age, appetite generally tapers off, growth slows for At 1 year of age, appetite generally tapers off, growth slows for now. now. – Children still need adequate nutrition. Children still need adequate nutrition. – The younger the child, the smaller the portions needed. The younger the child, the smaller the portions needed. – If children are offered nutritious foods in pleasant surroundings If children are offered nutritious foods in pleasant surroundings and in non-threatening ways. and in non-threatening ways. – The parents should decide which foods to serve at what time; The parents should decide which foods to serve at what time; the child should be able to decide what and how much to eat. the child should be able to decide what and how much to eat. – However this is also the time children test their independence. However this is also the time children test their independence.
  • 68.
    Encouraging Good DietaryHabits Encouraging Good Dietary Habits Meals at the table at regular times. Meals at the table at regular times. Relaxed and enjoyable. Relaxed and enjoyable. Variety of foods. Variety of foods. Do not force children to eat or clear plates. Do not force children to eat or clear plates. Small servings. Small servings. New foods. New foods. Nutritious snacks. Nutritious snacks. Limit sweets. Limit sweets. Encourage physical activity. Encourage physical activity. Adults are to set good eating habits. Adults are to set good eating habits.
  • 69.
    Adolescence Adolescence These years areof both physical and emotional growth. These years are of both physical and emotional growth.
  • 70.
    Diets are oftenfilled with kilocalorie-rich and Diets are often filled with kilocalorie-rich and nutrient-poor snack foods. nutrient-poor snack foods. Common dietary inadequacies include iron and Common dietary inadequacies include iron and calcium. calcium. Many teenagers experiment with alcohol and Many teenagers experiment with alcohol and drugs, which have detrimental effects on drugs, which have detrimental effects on nutrition. nutrition. Obesity is a common problem; weight reduction Obesity is a common problem; weight reduction diets should be attempted only under the advice diets should be attempted only under the advice of a physician and with the guidance of a of a physician and with the guidance of a dietitian. dietitian.
  • 71.
    Adult Adult With energy, activitydecreasing, weight gain With energy, activity decreasing, weight gain increasing: Nutritional needs start to decrease. increasing: Nutritional needs start to decrease.
  • 72.
    Older Adult Considerations OlderAdult Considerations Aging may affect the eating process. Aging may affect the eating process. Aroma and taste of food may change. Aroma and taste of food may change. Changes in the digestion process. Changes in the digestion process. Kilocalorie needs decrease . Kilocalorie needs decrease . Numerous medications. Numerous medications. Social and mental changes. Social and mental changes. Chronic medical conditions. Chronic medical conditions.
  • 73.
    Malnutrition is acommon problem among nursing Malnutrition is a common problem among nursing home residents and profoundly influences physical home residents and profoundly influences physical health and quality of life. health and quality of life. Residents should be offered familiar foods that taste Residents should be offered familiar foods that taste good. good. Fluids should be offered to residents at all meals and Fluids should be offered to residents at all meals and between meals. between meals. Dehydration is very common and easily corrected in Dehydration is very common and easily corrected in long term care facilities. long term care facilities. Nutritional Concerns of Adults in Long Term Care Facilities
  • 74.
    Nurses must understandthe value of mealtime as a Nurses must understand the value of mealtime as a pleasant, social experience. pleasant, social experience. Cultural and personal preferences should be considered. Cultural and personal preferences should be considered. Many residents need assistance or encouragement. Many residents need assistance or encouragement. Lack of adequate staffing play a large role in patient Lack of adequate staffing play a large role in patient nutrition. nutrition. Many patients are on restricted diets. Many patients are on restricted diets. Pressure sore due to lack of mobility, and nutrition. Pressure sore due to lack of mobility, and nutrition. Nutrient-Drug interactions. Nutrient-Drug interactions.
  • 75.
    Caffeine Caffeine Caffeine: Caffeine: Drug Drug Central nervous systemstimulant and diuretic. Central nervous system stimulant and diuretic. Nervousness Nervousness Irritability Irritability Anxiety Anxiety Insomnia Insomnia Heart arrhythmias Heart arrhythmias Palpitations Palpitations See Caffeine Content of Selected Beverages and Foods. See Caffeine Content of Selected Beverages and Foods.
  • 76.
    Common Medications andTheir Effect on Common Medications and Their Effect on Nutrition Nutrition Antacids. Antacids. Antibiotics. Antibiotics. Anticoagulants. Anticoagulants. Aspirin. Aspirin. Diuretics. Diuretics. Laxatives. Laxatives.
  • 78.
    Medical Nutrition Therapy MedicalNutrition Therapy and Therapeutic Diets and Therapeutic Diets These diets are specific nutrition as needed to treat an illness, injury or These diets are specific nutrition as needed to treat an illness, injury or condition. condition.
  • 79.
    Purpose of DietTherapy Purpose of Diet Therapy The dietary prescription is written for one or The dietary prescription is written for one or more of the following purposes: more of the following purposes: Provide the client with nutrients needed for Provide the client with nutrients needed for maintenance or growth. maintenance or growth. Prepare a client for diagnostic tests. Prepare a client for diagnostic tests. Treat the client with a disease or condition. Treat the client with a disease or condition.
  • 80.
    DIET THERAPY DIET THERAPY Thetreatment of a disease or The treatment of a disease or disorder with a special diet. disorder with a special diet. A client must not be given A client must not be given anything to eat or drink without anything to eat or drink without an order. an order.
  • 81.
    The Vegetarian Diet TheVegetarian Diet Lacto-ovo vegetarians–use dairy Lacto-ovo vegetarians–use dairy products and eggs but no meat, products and eggs but no meat, poultry, or fish. poultry, or fish. Lacto vegetarians–use dairy products Lacto vegetarians–use dairy products but no meat, poultry, or eggs. but no meat, poultry, or eggs. Vegans–avoid all animal foods. Vegans–avoid all animal foods.
  • 82.
    Factors Influencing Diet FactorsInfluencing Diet Culture Culture Religion Religion Socioeconomics Socioeconomics Fads Fads Superstitions Superstitions
  • 83.
    BASIC BASIC NUTRITIONAL ASSESSMENT NUTRITIONAL ASSESSMENT Nutritionalstatus Nutritional status Height and weight Height and weight Meal and snack pattern Meal and snack pattern Food allergies Food allergies Physical activity Physical activity Cultural, ethnic, and family influences Cultural, ethnic, and family influences Use of vitamin/mineral supplements Use of vitamin/mineral supplements
  • 84.
    NUTRITION AND HEALTH NUTRITIONAND HEALTH Primary nutritional disease–occurs Primary nutritional disease–occurs when nutrition is the cause of the when nutrition is the cause of the disease. disease. Secondary nutritional disease– Secondary nutritional disease– occurs as a complication of occurs as a complication of another disease or condition. another disease or condition.
  • 85.
    WEIGHT MANAGEMENT WEIGHT MANAGEMENT Basedon relationship between Based on relationship between intake and use of kcal. intake and use of kcal. Overweight: 11%–19% above Overweight: 11%–19% above Obesity: 20% or more above Obesity: 20% or more above Underweight: 10%–15% under Underweight: 10%–15% under
  • 86.
    FOOD LABELING FOOD LABELING Requiredon virtually all retail food Required on virtually all retail food products. products. Labels must follow the approved uniform Labels must follow the approved uniform format and use standard serving sizes format and use standard serving sizes and household measurements. and household measurements.
  • 88.
    FOOD QUALITY ANDSAFETY FOOD QUALITY AND SAFETY Proper storage, preparation, Proper storage, preparation, sanitation, and cooking are sanitation, and cooking are necessary to help prevent or reduce necessary to help prevent or reduce the risk of food-borne illnesses. the risk of food-borne illnesses.
  • 89.
    Consistency, Texture, andFrequency Consistency, Texture, and Frequency Modifications Modifications Liquid Diets: Liquid Diets: Clear Liquids Clear Liquids Full Liquids Full Liquids Soft and Low-Residue Diets. Soft and Low-Residue Diets. High Fiber Diets. High Fiber Diets. Meal Frequency Modification. Meal Frequency Modification.
  • 90.
    Kilocalorie Modifications Kilocalorie Modifications BasalMetabolic Rate (BMR). Basal Metabolic Rate (BMR). High-Kilocalorie and High Protein Diets. High-Kilocalorie and High Protein Diets. Anorexia. Anorexia. Kilocalorie-Controlled and Low-Kilocalorie Diets. Kilocalorie-Controlled and Low-Kilocalorie Diets. Obesity Obesity Measurements of Obesity Measurements of Obesity BMI BMI Body Composition Body Composition Waist circumference Waist circumference Treatment of Obesity Treatment of Obesity
  • 91.
    Eating Disorders Eating Disorders AnorexiaNervosa: Anorexia Nervosa: Self-imposed starvation. Self-imposed starvation. Individuals have an intense drive for thinness, Individuals have an intense drive for thinness, an intense fear of gaining weight or becoming an intense fear of gaining weight or becoming fat, and a distorted body image. fat, and a distorted body image. Bulimia Nervosa: Bulimia Nervosa: Periods of binge eating followed by purging Periods of binge eating followed by purging (self-induced vomiting, emetics, laxatives, (self-induced vomiting, emetics, laxatives, enemas, or diuretics). enemas, or diuretics). Often normal weight or overweight. Often normal weight or overweight. Binge / Purge: Binge / Purge:
  • 92.
    Comparison of EatingDisorders Comparison of Eating Disorders Diagnoses Diagnoses Body weight and other physical Body weight and other physical indicators. indicators. Eating behaviors. Eating behaviors. Compensatory behaviors (purging). Compensatory behaviors (purging). Psychologic indicators. Psychologic indicators.
  • 93.
    Carbohydrate-Modified Diets Carbohydrate-Modified Diets DiabetesMellitus: Diabetes Mellitus: A disease in which the body does not produce or A disease in which the body does not produce or properly properly use insulin. use insulin. Insulin convert sugar, starches, and other food into Insulin convert sugar, starches, and other food into energy needed for daily life. energy needed for daily life. Two major types of diabetes: Two major types of diabetes: Type 1 Type 1 Type 2 Type 2
  • 94.
    Primary goals formedical nutrition therapy: Primary goals for medical nutrition therapy: – Improve metabolic control by achieving Improve metabolic control by achieving and maintaining optimal blood glucose. and maintaining optimal blood glucose. – Provide adequate energy for maintenance Provide adequate energy for maintenance of a reasonable body weight. of a reasonable body weight. – Prevent acute and chronic complications Prevent acute and chronic complications of diabetes. of diabetes. – Improve overall health through optimal Improve overall health through optimal nutrition nutrition
  • 95.
    Carbohydrate intake shouldbe monitored and Carbohydrate intake should be monitored and controlled. controlled. Diabetic diet tools: Diabetic diet tools: –Exchange lists for meal planning Exchange lists for meal planning –Carbohydrate counting Carbohydrate counting Other nutritional considerations: Other nutritional considerations: –Hypoglycemia: consumption of inadequate Hypoglycemia: consumption of inadequate carbohydrates causes the blood sugar to carbohydrates causes the blood sugar to drop. drop.
  • 96.
    Carbohydrate-Modified Diets Carbohydrate-Modified Diets(continued) (continued) – Dumping Syndrome: Dumping Syndrome: It may occur after surgery in which a portion It may occur after surgery in which a portion or all of the stomach is removed. or all of the stomach is removed. – Lactose Intolerance: Lactose Intolerance: Intolerance occurs as a result of a lack of the Intolerance occurs as a result of a lack of the digestive enzyme lactase. digestive enzyme lactase.
  • 97.
    Special Diets Special Diets Low-residuediet Low-residue diet High-fiber diet High-fiber diet Liberal bland diet Liberal bland diet Fat-controlled diet Fat-controlled diet Sodium-restricted diet Sodium-restricted diet
  • 98.
    Fat Modified Diet FatModified Diet These diets are beneficial in reducing the risk of atherosclerosis. These diets are beneficial in reducing the risk of atherosclerosis. Lowering dietary fat may assist in disease treatment and control. Lowering dietary fat may assist in disease treatment and control.
  • 99.
    Fat-Controlled Diets: Fat-Controlled Diets: Limitstotal fat, saturated fat, and Limits total fat, saturated fat, and trans-fatty acids. trans-fatty acids. Low-Fat Diets: Low-Fat Diets: All fats limited, regardless of saturation. All fats limited, regardless of saturation.
  • 100.
    Lowering Fat/Saturated Fat/TransFatty Lowering Fat/Saturated Fat/Trans Fatty Acids/Cholesterol Acids/Cholesterol Food Groups: Food Groups: Choose: Choose: Go Easy on: Go Easy on:
  • 101.
    Protein/Electrolyte Protein/Electrolyte and and Fluid-Modified Diets Fluid-Modified Diets Increasedprotein facilitate healing. Increased protein facilitate healing. Defects in protein is seen in liver/renal disease. Defects in protein is seen in liver/renal disease.
  • 102.
    Sodium-Restricted Diets: Sodium-Restricted Diets: pg649 box 21-9 pg 649 box 21-9 Potassium-Modified Diets: Potassium-Modified Diets: Fluid-Modified Diets: Fluid-Modified Diets: Fluid Restrictions Fluid Restrictions Fluid Increase Fluid Increase
  • 103.
    Patient Teaching Patient Teaching Fluidrestrictions: Fluid restrictions: Explain the rationale. Explain the rationale. Indicated if restriction is temporary or permanent. Indicated if restriction is temporary or permanent. Educate, discuss different sources of water. Educate, discuss different sources of water. Teach how to count fluids. Teach how to count fluids. Show the patient how much fluid is allowed. Show the patient how much fluid is allowed. Suggest ways to alleviate thirst without drinking. Suggest ways to alleviate thirst without drinking. Discuss the consequences of over consumption of fluids. Discuss the consequences of over consumption of fluids.
  • 104.
  • 105.
    Nutritional Support Nutritional Support Enteralnutrition–includes both the Enteral nutrition–includes both the ingestion of food orally and the delivery of ingestion of food orally and the delivery of nutrients through a GI tube. nutrients through a GI tube. Parenteral nutrition–the infusion of a Parenteral nutrition–the infusion of a solution of nutrients directly into a vein to solution of nutrients directly into a vein to meet the client’s daily requirements. meet the client’s daily requirements.
  • 106.
    Tube Feedings Tube Feedings –Administration of nutritionally balanced liquefied Administration of nutritionally balanced liquefied foods or formula though a tube inserted into the foods or formula though a tube inserted into the stomach, duodenum, or jejunum by way of a stomach, duodenum, or jejunum by way of a nasogastric tube or a feeding ostomy. nasogastric tube or a feeding ostomy. – Indicated when a patient is unable to chew or Indicated when a patient is unable to chew or swallow, has no appetite, or refuses to eat. swallow, has no appetite, or refuses to eat. – Tube feeding used only when all or at least part Tube feeding used only when all or at least part of the GI tract is functioning. of the GI tract is functioning. – Feeding given continuously or intermittently. Feeding given continuously or intermittently.
  • 107.
    Figure 21-7 Figure 21-7 Tubefeeding sites. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
  • 109.
    Nasogastric Tube Feedings NasogastricTube Feedings Checking for placement of a feeding tube before Checking for placement of a feeding tube before administering medication or tube feeding is critical administering medication or tube feeding is critical to safe patient care. to safe patient care. Tube may be accidentally placed in the lung, Tube may be accidentally placed in the lung, esophagus, or even the stomach when it should esophagus, or even the stomach when it should be in the small bowel. be in the small bowel. To test, use chest x-ray, test pH of aspirated fluid, To test, use chest x-ray, test pH of aspirated fluid, or use auscultatory method. or use auscultatory method.
  • 110.
  • 111.
    Skill 21-1: Step10a(1) Skill 21-1: Step 10a(1) Administering nasogastric tube feedings. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
  • 112.
    Skill 21-1: Step10a(2) Skill 21-1: Step 10a(2) Administering nasogastric tube feedings. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
  • 113.
    Skill 21-1: Step10b Skill 21-1: Step 10b Administering nasogastric tube feedings. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing [6th ed.]. St. Louis: Mosby.)
  • 114.
    Administering nasogastric tubefeedings. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
  • 115.
    Administering nasogastric tubefeedings. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
  • 116.
    Parenteral Nutrition Support ParenteralNutrition Support – Parenteral nutrition ( Parenteral nutrition (hyperalimentation hyperalimentation): ): Intravenous feedings. Intravenous feedings. May be administered through peripheral veins. May be administered through peripheral veins. – Total parenteral nutrition (TPN): Total parenteral nutrition (TPN): Administration of hypertonic solution into a large Administration of hypertonic solution into a large central vein. central vein. Composed of glucose, amino acids, vitamins, minerals, Composed of glucose, amino acids, vitamins, minerals, and electrolytes; fats also given as a supplement to the and electrolytes; fats also given as a supplement to the main formula. main formula. Indicated for the patient with a nonfunctioning or Indicated for the patient with a nonfunctioning or dysfunctional GI tract. dysfunctional GI tract.
  • 117.
    Figure 21-8 Figure 21-8 Centralvenous catheter placement during administration of parenteral nutrition. (Courtesy of Rolin Graphics.)
  • 118.
    Nursing Assessment Nursing Assessment Mustbe performed in a logical fashion Must be performed in a logical fashion and should include a nutritional and should include a nutritional history, physical examination, and the history, physical examination, and the results of laboratory tests. results of laboratory tests.
  • 119.
    Nursing Diagnosis Nursing Diagnosis Imbalancednutrition: Imbalanced nutrition: – Less than body requirements Less than body requirements – More than body requirements More than body requirements Risk for imbalanced nutrition: more than Risk for imbalanced nutrition: more than body requirements body requirements Disturbed body image Disturbed body image Ineffective breastfeeding Ineffective breastfeeding
  • 120.
    Impaired dentition Impaired dentition Deficientknowledge (specify) Deficient knowledge (specify) Impaired oral mucous membrane Impaired oral mucous membrane Pain Pain Feeding self-care deficit Feeding self-care deficit Chronic low self-esteem Chronic low self-esteem Risk for impaired skin integrity Risk for impaired skin integrity
  • 121.
    Planning / Outcome Planning/ Outcome A plan should be formulated by the A plan should be formulated by the nurse and client to achieve mutually nurse and client to achieve mutually agreed-upon goals. agreed-upon goals. The plan is individualized to meet The plan is individualized to meet the client’s specific needs. the client’s specific needs.
  • 122.
    Implementation Implementation Interventions to accomplishthe goals Interventions to accomplish the goals may include diet therapy, assistance may include diet therapy, assistance with meals, weight and intake with meals, weight and intake monitoring, and nutritional support. monitoring, and nutritional support.
  • 123.

Editor's Notes

  • #13 Essential Nutrients (continued) Basic Functions Provide energy Carbohydrates and proteins: 4 kcal/g Fat: 9 kcal/g Build and repair tissue Protein, calcium, phosphorus, iron, and fat Regulate body processes Metabolism: the combination of all chemical processes that take place in living organisms
  • #15 Carbohydrates Main function of carbohydrates is to provide energy. Simple carbohydrates Simple sugars: monosaccharides and disaccharides Found naturally in many nutritious foods such as milk and fruit Complex carbohydrates Polysaccharides Starch, glycogen, and dietary fiber Digestion and metabolism of carbohydrates All carbohydrates except fiber are broken down in the digestive tract into monosaccharides (simple sugar units). They then are absorbed and eventually converted to glucose. Glucose circulates in the bloodstream and is used by the cells for energy. Digestion and metabolism of carbohydrate If energy needs are met, carbohydrates will be stored as glycogen. Once glycogen stores are full, further excesses of carbohydrates will be converted to fat and stored as adipose tissue. Digestion and metabolism of carbohydrate If energy needs are met, carbohydrates will be stored as glycogen. Once glycogen stores are full, further excesses of carbohydrates will be converted to fat and stored as adipose tissue.
  • #20 Fats (Lipids) These are a group of organic substances of a fatty nature that are insoluble in water and that are necessary in the body for good health. Both fats and cholesterol are lipids. Adipose tissue is the body’s storage form of fat; it helps insulate the body from temperature extremes and serves as a cushion to protect organs and other tissues. Fat provides satiety; it adds flavor and aroma to foods. Digestion and metabolism of fats Fats must be emulsified by bile to be digested. Once emulsified, fats can be broken down and absorbed. Excess dietary fat will be stored as adipose tissue. Lipoproteins facilitate the transport of lipids in the bloodstream: high-density (HDL) and low-density (LDL) lipoproteins.
  • #21 Saturated fatty acids Chemical bonds are completely filled or saturated with hydrogen. These are generally of animal origin and solid at room temperature. They increase blood cholesterol levels and the risk of atherosclerosis. Unsaturated fatty acids There is one or more places on its chemical chain where hydrogen is missing. They can be monounsaturated or polyunsaturated. They usually have plant sources and are liquid at room temperature. They are thought to have a blood cholesterollowering effect at moderate levels of intake. Trans-Fatty Acids These are unsaturated fatty acids that vary slightly in their chemical configuration from naturally occurring unsaturated fatty acids. They are produced during hydrogenation. They are found in foods containing partially hydrogenated vegetable oils. They tend to increase blood cholesterol levels but not as much as saturated fats.
  • #22 Cholesterol It performs specific functions in the body but provides no energy. It is synthesized in the liver and is found in foods of animal origin. Dietary cholesterol is highest in organ meats and egg yolks. Intake of dietary cholesterol should average no more than 300 mg per day.
  • #28 Protein Protein makes up the bulk of the body’s lean tissues and organs. It is necessary for tissue growth and repair and wound healing. Protein is made of smaller units called amino acids There are 22 amino acids, but only 9 of them are considered essential amino acids. The 9 essential amino acids must be obtained from the diet. Complete Proteins One that contains all nine essential amino acids in sufficient quantity and ratio for the body’s needs Generally of animal origin; found in foods such as meat, poultry, fish, milk, cheese, and eggs Incomplete Proteins Lacking in one or more or the essential amino acids Plant origin; include grains, legumes, nuts, and seeds Vegetarian Diets They are made up of mainly plant foods; some may include dairy products or eggs as well. Lactovegetarin diet includes fruits, vegetables, grains, and milk and dairy products. Lacto-ovo-vegetarian diet also includes eggs. Protein needs can be met with a vegetarian diet; a wide variety of plant foods must be included. Protein-Kilocalorie Malnutrition Individuals suffering from a lack of kilocalories or protein; body breaks down its own protein stores for energy Kwashiorkor: malnutrition caused by severe protein deficiency; may occur in the presence of adequate kilocalories Marasmus: condition of extreme malnutrition and emaciation due to inadequate kilocalories and protein
  • #33 Vitamins and Minerals They are needed in small amounts; toxicity may occur with over consumption. They are best received from a balanced, varied diet. Vitamins can be destroyed by heat, light, and exposure to air. Minerals cannot be destroyed because they are single elements rather than compounds. Both vitamins and minerals can be lost when foods are cooked in water. Vitamins (continued) Antioxidant vitamins Vitamins E and C; previtamin form of A (beta-carotene) Possible link to reduced risks of certain cancers and heart disease Function by delaying or preventing the destruction or breakdown of cell membranes in the presence of oxygen
  • #42 Vitamins (continued) Vitamin C Adequate amounts are necessary for proper immune function. Vitamin D Most common dietary sources include fortified milk and milk products. The body can also make vitamin D from exposure to sunlight.
  • #43 Vitamin K It plays a role in blood clotting. A large fluctuation in vitamin K intake may alter the effects of anticoagulation drugs. Folate (folic acid) Before and during pregnancy, it may play a role in reducing the risk of neural tube defects in the infant. Vitamin B12 It is primarily found in foods of animal origin. It requires a special intrinsic factor produced in the stomach for absorption. Pernicious anemia may result with inadequate amounts of intrinsic factor because B12 is not absorbed.
  • #45 Minerals Major minerals are those needed in amounts greater than 100 mg per day: calcium, phosphorus, magnesium, sulfur, sodium, potassium, and chloride. Trace minerals are needed in much smaller amounts: iron, zinc, iodine, selenium, copper, fluoride, chromium, and molybdenum. Calcium Protective effect against osteoporosis and hypertension 1000 to 1200 mg per day Sodium Functions as an electrolyte Less than 2400 mg per day Salt is a major dietary source
  • #46 Potassium An electrolyte; may have a protective effect against hypertension 2000 mg per day Iron Part of hemoglobin, which is part of the red blood cell and carries oxygen to the cells 8-15 mg per day; 30 mg per day for pregnant women
  • #55 Dietary Guidelines for Americans These guidelines form the foundation of U.S. federal nutrition policy and directly affect federal nutrition programs such as food stamps, school breakfast and lunch programs, and the Special Supplemental Program for Women, Infants, and Children (WIC). These guidelines have been developed to address the importance of adequate nutrition, as well as the prevention of over nutrition and disease.
  • #56 MyPyramid (continued) Symbolizes a personalized approach to healthy eating and physical activity. Emphasizes key concepts regarding activity and eating. Activity Moderation Variety Proportionality
  • #62 Concerns in Pregnancy Weight gain Normal-weight women should gain between 25 and 35 lb. Discomforts and complications Pregnancy-induced hypertension (PIH) Proper nutrition may help avert this condition; salt should not be restricted in most cases. Gestational diabetes Diabetes mellitus that occurs only during pregnancy; diet major part of therapy Anemia Iron deficiency and folacin deficiency Adequate diet including meats, poultry, and fish; green leafy vegetables; and variety of fruits Practices to avoid Alcohol consumption Caffeine consumption; less than 300 mg per day Smoking Lactation Additional 500 kcal per day is recommended; increased fluid needs Adequate nutrition vital
  • #65 Breast milk or iron-fortified infant formula is generally recommended for the first year. Breastfeeding should be encouraged Regular cow’s milk is inappropriate during the first year. Infants need high % of kilocalories from fat. Non Low fat provides inadequate fat, and difficult to digest. Whole cow milk infants have low iron, essential fatty acids, vit E, excess sodioum potassium, protien. After year one, only whole milk may be used. Introducing solid foods too early may increase the risk for food allergies and choking. Most infants are not developmentally or physiologically ready to handle solid foods before 6 months of age. At 4 to 6 months of age, single-ingredient foods should be chosen and introduced one at a time at weekly intervals.
  • #71 It is important to use nutrient-dense foods and thereby receive adequate nutrition and fewer kilocalories. With age comes the increasing likelihood of age-related illness;
  • #73 nutrient needs vary greatly from individual to individual.
  • #89 Liquid diets Clear liquid diet is a nonirritating diet consisting of liquids that are easily digested and absorbed and leave little residue in the GI tract: bouillon, broth, gelatin, tea, coffee, ginger ale Full liquid diet is more nutritionally complete than a clear liquid diet but is still lacking in some nutrients: strained cereals and soups, ice cream, puddings, milk/milkshakes, and fruit juices Soft and low-residue diets Soft diet is generally low in fiber; includes foods from all five food groups and is nutritionally adequate except for fiber. Low-residue diet is similar to the soft diet but also includes restrictions on milk, because it leaves more residue in the colon. Mechanical soft diet eliminates foods that are difficult to chew or swallow. Nutrition Therapy in Peptic Ulcer Disease Eat three regular meals per day, without snacks. Avoid known gastric acid stimulants: coffee, caffeinated soft drinks, tea, hot chili peppers, and alcohol. Individualize the diet according to patient tolerance, eliminating any specific food or spice that causes discomfort. Avoid cigarette smoking, aspirin, and nonsteroidal antiinflammatory drugs. High-Fiber Diets This is a variation of the regular diet that doubles the intake of dietary fiber. Foods with high fiber should replace similar foods with little or no fiber. It is used for the treatment of some GI disorders. Meal Frequency Modification Small, frequent meals may be used rather than three larger meals: six to eight small meals or snacks. This decreases workload on the GI tract and cardiovascular system.
  • #90 High-kilocalorie and high-protein diets During times of physiological stress, the body’s energy and protein needs are increased. Diet should provide increased amounts of kilocalories and protein in small volumes. The diet should still provide a balance of foods from all of the food groups. Nutritional support in the form of tube feedings or IV feedings may be considered. Kilocalorie-controlled and low-kilocalorie diets Used in the treatment of obesity and in the prevention of excess weight gain Measurements of obesity Height and weight tables Body mass index (BMI) Body composition Waist circumference Treatment of obesity It should involve both behavioral and psychological goals. Diet should be low in fat and have an energy level that does not exceed expenditure. Physical activity is an integral part of any weight management effort.
  • #91 Binge Eating Disorder Frequent, recurrent episodes of binge eating; eating larger amounts of food than normal during a short period of time and feeling a lack of control over eating during binge episodes Often obese; should consider treatment that focuses on binge eating behavior before attempting to lose weight
  • #93 Primary goals for medical nutrition therapy Improve metabolic control by achieving and maintaining optimal blood glucose Provide adequate energy for maintenance of a reasonable body weight. Prevent acute and chronic complications of diabetes Improve overall health through optimal nutrition
  • #96 Dumping Syndrome It may occur after surgery in which a portion or all of the stomach is removed. The stomach contents may empty too rapidly into the jejunum; the body reacts by sending water to the intestinal tract, thus reducing blood pressure. The load in the intestinal tract increases peristalsis, leading to diarrhea. Diet therapy involves giving small frequent meals that are higher in protein and fat and lower in carbohydrates. The GI tract is unable to break down lactose. Symptoms occur after the ingestion of milk products and include nausea, cramps, bloating, flatulence, and diarrhea. Diet for lactose intolerance excludes milk and milk products; foods with milk added may need to be avoided as well.
  • #99 Fat controlled diets Limits total fat, saturated fat, and trans-fatty acids. To prevent and treat atherosclerosis, heart disease, and hyperlipidemia. Rather than totally eliminating high-fat foods, encourages moderation. Low-Fat Diets: All fats limited, regardless of saturation. Used for diseases that involve malabsorption of fat.
  • #102 Protein-Restricted Diet In the presence of defects in protein metabolism or excretion, protein intake reduced or controlled; chronic renal failure and cirrhosis of the liver Sodium-Restricted Diet May be used to treat hypertension, water retention, edema, and congestive heart failure Restrictions range from “no added salt” to as little as 500 mg sodium per day Fluid-Modified Diets Fluid is restricted to 500 to 750 ml per day plus an amount equal to daily urine output during end-stage renal disease. Fluid restrictions may also be implemented during congestive heart failure, directly after a myocardial infarction, or in hepatic coma or ascites. Patient may experience excessive thirst: rinse mouth with cold mouthwash, lemon in cold water, freezing fluids, cold fruits and vegetables, breath mints or hard candies, and brushing teeth.