Water is most basic need. Carbohydrates, fats, proteins. – energy producing Micronutrients – Vitamins and Minerals = Metabolize the energy producing nutrients.
Carbs – sugars – simple carbs Starches and fiber – complex carbs Sugars – mono or di saccharides, glucose Lactose – sugar found in milk of animals Starches insoluble, nosweet forms of carbs grains, legumes, potatoes Cereals, breads, flour pudding – processed from starches Fiber from plants = outer layer of grains, bran, skin, seeds pulp of veges and fruits. Proteins = amino acids. Essential and nonessential meat, poultry, fish, dairy products, eggs = complete proteins = contain all essential aa Incomplete proteins lack one or more essential aa – from vegetables. Fats = lipids Solid at room temp. Oils – lipids that are liquid Fatty Acids are basic sturctural units of most lipids. Saturated (butter) or unsaturated. Unsat FA may be mono or poly unsaturated. Lipids are simple glycerides or compound – triglycerides Saturated or unsaturated. Saturated – butter unsaturated = olive or corn oil. Cholesterol fat like substance produced by body – found in foods of animal origin. Vitamins are water soluable (C and G complex) or fat soluble ( A, D, E, K) Fresh veggies consumed asap post harvest. Minerals – orgnaic compounds. Free ions. Macro minierals – Large over 100 mg needed - CA, PH, NA, K, MG, CL, sufur. Micro minerals – acquire daily in amounts less than 100 mg zinc, manganese, iodine, fluoride, copper, cobalt, cromium, selenium
Age: Primmies are at risk of under nutrition <5.5 lbs need monitoring are given tube feedings carefully because suck swallow reflex are not developed . Adolescents the eating disorders are common 20 million suffer from eating disorders and can grave consequences heartaches from the electrolyte changes that occur with binging and purging. Older adults there is a decrease in metabolism, increase connective tissue to functioning cell, reduced secretion on HCL acid in stomach limits absorption of calcium, iron and vitamin B12, 50% of those over 65 wear dentures if poor fitting patients have problems eating and after surgery the usually is a change in gum structure and when the dentures are put on they don ’t fit. Many elderly clients take a Molotov cocktail of meds which usually interact with nutrients Socioeconomic status: Food expenses are not fixed and spending varies with monies available 2. a lot of convenience foods and starchy foods Physiological factors : 1. factors that affects the ingestion of food are those that affect appetite , like anorexia and wasting syndrome , the mouth stomatitis lesions of the mouth and throat , and or esophagus or with swallowing, as with dysphagia, lactose intolerance, colitis, ETOH and Drugs:
Page 547 table 24.4
Easy to swallow foods box 24.8
8 nutrition - nursing
Nursing Fundamentals Focus VIII Meeting Nutritional Needs
List b surv asic su sign ival. Dis bstance of th ificance cuss the s for eir im of ea s Defin port ch in ance orde c tive and e the 6 . r nutri iden food prov ents tify the m groups reco ides each gr ajor mme, includi oupOb je allow n ancended da g the Calc s. ily needulated e plan and de stimate d adeq per day sign a m caloric and uate ca to main eal idea l t l weioric bala ain ght. nce
Comp pare situa a tion/ nd contr resp cond ast th onsib ition e s prob le f o s c tive lems r nut rition al DescrOb je ribe main alter taini ed m ng a nutri tiona dequ eans of nurs l inta ate i ng r ke. E each espo . nsib xplain ilitie s f or
Energy Production and Physiological MaintenanceEssential Nutrients and SourcesWaterFluid and ElectrolytesNutrients
Esse Esse ients ntial Sources ntialNut r rates ohyd Carb and and S Fats Nutr Nutri eins Prot ourc utri ents erals ients ents Mi cron a nd min mins es Vita
Food groupsDaily allowance:Bread and cerealVegetableFruitDairyMeatFat and sweet
ic Activ ce ca lo r ity ne ed: b alan ener rgy re comp quire letely men intak met t s ar u at e e in f ood by ca e main with loric tain peop leve thei le wh l s wi r ac oAde q chan thou tivity ge. t wei ght
Adequate caloric balance Total Caloric NeedVs Total Caloric Intake
Lab TestsBUNHematocritHemoglobinBUN : Creat ratioAlbuminSerum CreatinineLymphocyte Count
Health statu Age s g t us f ect in Socio econ l St a Physi ologi omic statu s rs Af Alcoh c a l fa ctors ti ona ol an Cultur d drugs F act o e an Misinf d lifestyleNu tr i forma ti o n a n d fa ds
Factors Affecting Nutritional StatusHealth status:1. a good appetite is a sign of health.2. anorexia is usually a symptom of disease or can be a side effect of drugs.3. Nutritional support is an essential part of recovery from any medical treatment.
Factors Affecting Nutritional Status Age Premature babies (32-34 weeks) <5.5 lbs Adolescents the eating disorders are common approx 20 million sufferers Older adults Many elderly clients take a Molotov cocktail of meds which usually interact with nutrients
Soci oeco nom ic sta tus: g 1. Foo t us f ect in d exp l St a fixed ense s are 2. Spe rs Af not ti ona nding mon v ies a aries wi 3. A lo F act o vaila th bleNu tr i t of c food onve s and nienc starc e hy f o ods
l lo gica hysio sP orFact b olism Meta e iseas ver d Fact li Facto Nutri n NutritIng estio ction xia infe nore a is ors A matit tiiona sto rs Aff ia onall dys phag and nd on a tion ffectii s i a igest bsorp raum ec t n g Statu D t Statu A e ve ulc erati ng coliti s s se lacto ce an in toler
Factors Affecting Nutritional StatusAlcohol and drugs:1. Abuse contributes to nutritional deficiencies because money may be spent on alcohol instead of food, and alcohol may replace apart of the diet and depress appetite2. Excess alcohol can also affect GI organs3. Drugs that depress appetite can lower the intake of essential nutrients4. Drugs can also deplete nutrient stores and lessen absorption
C u lt u re an d life s t y le 1.. Cultu : g patte ral, ethn t us conc rns and ic, and f ect in into aerning fo restrictioreligious l St a ccou o n nt d must b s e tak en rs Af 2. ti ona Spec be g ial food iven s when and die F act o ever ts shoNu tr i poss u ible ld 3. Olde cling r adults tend to ethni are mor durinency ma c food h e apt to g illn y a ess. be increbits. This ased
Factors Affecting Nutritional StatusMisinformation and fads:1. Food myths can be the result of cultural background, popular interest in natural foods, peer pressure, and a desire to control weight.2. Food fads often involve erroneous beliefs that certain foods are especially healthy.3. Nurses must make sure not to be condescending when teaching a client that foods may not have qualities attributed to them.
Nutritional Assessment and Support Albumin<3.5? Total lymphocyte Count <1800 Is weight <80% of ideal? Assessment of Oral & GutPsychosocial and Is Gut functioning ? Nutritional not functioningPhysical barriers supplements? TPN candidate to intake Adequate Ongoing TPN Dietary Intake? Assessment Tube Feeding Ongoing Assessment
Clinical Situations which Artificial Nutrition may be Necessary Inability to ingest food CA of the mouth, tongue, esophagus Facial trauma Unconsciousness Severe stomatitis Dysphagia Muscle weakness in mouth and esophagus Pancreatitis, CA or the stomach Inabilityfood to digest or Crohn’s disease/ulcerative colitis absorb Biliary disease Increase resting energy expenditure from major trauma and surgery, burns, severe infection Anorexia and Bulimia Nervosa
Imbalanced NutritionFocused assessment what are the physical and psychosocial barriers to nutrition?Body weight<20% of idealAppetiteMedicationsAbility to eat independentlyDifficulty with the mechanics of eatingGI symptomsPhysical conditionFinances
ire d g l lowi n I mp a DYSPHAGIA: Oral phaseSwa Pharyngeal phase Esophageal phase
n ra ti o Aspi fo rRi sk LOOK AT RELATED FACTORS!
Increase Nutrient IntakeNursing ResponsibilitiesProviding Enteral Feedings- Enteral nutrition- Feeding tubes and routes of access - Types of formulas - Administration of feedings - Complications of feedings- Home Enteral Nutrition
Increase Nutrient Intake N Nursing ResponsibilitiesEnriching the Insufficient Diet- Special populationsManaging Therapeutic Diets- Anorexia- Nausea and vomiting- Lactose Intolerance- Malabsorption- Diabetes- AIDS and CA- Heart Disease- Kidney Disease- Liver Disease
Managing Impaired Swallowing: Nursing ResponsibilitiesPositioning the patientEncouraging the appropriate foods- Easy to swallow foods
Reduce Risk of Aspiration Nursing ResponsibilitiesMonitor for subtle cues: change in respiratory rate temperature breath sounds decrease oxygen saturation check swallowing reflex check for increased gastric residual volume positioning need for suctioning