Unit 3 Part E - Ch. 45 Nutrition

Fat-soluble vitamins

-(A, D, E, and K)-are stored in the fatty compartments of the body

Lipids

-(fats)- the most calorie-dense nutrient, providing 9 kcal/g, composed of triglycerides and fatty acids

Carbohydrates

-Composed of carbon, hydrogen, and oxygen, are the main source of energy in the diet. Each gram of carbohydrate produces 4 kcal/g and serves as the main source of fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla. We obtain carbs primarily from plant foods, except for lactose (milk sugar).

Malabsorption

-Condition in which the small intestine cannot absorb nutrients from food that passes through it

Malnutrition

-Condition that develops when the body is deprived of vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function

Vegetarianism

-Consumption of a diet consuming predominantly of plant foods

Dysphagia

-Difficulty swallowing

BOX 45.6 Nursing Assessment Questions

Dietary Intake and Food Preferences -What type of food do you like? -How any meals a day do you eat? -Tell me about your dietary religious or cultural food preferences. -How do you cook your food (e.g., fried, broiled, baked, grilled) ? Unpleasant Symptoms -Which foods cause indigestion, gas, or heartburn? Allergies -Are you allergic to any foods? Taste, Chewing, and Swallowing -Have you noticed any changes in taste? -Do you wear dentures? -Do you have difficulty swallowing? Appetite and Weight -Any recent changes in appetite? -Any recent changes in your weight? Use of Medications -Which medications do you take? -Any over the counter meds that your doctor doesn't prescribe? -Do you take any nutritional or herbal supplements?

BOX 45.9 Patient Teaching - Food Safety

1. CLEAN 2. SEPARATE 3. COOK 4. CHILL

Fiber

-A polysaccharide, is the structural part of plants that is not broken down by our digestive enzymes. The inability to breakdown fiber means that it does not contribute calories to the diet. Therefore, insoluble fibers, including cellulose, hemicellulose, and lignin, are not digestible. Soluble fibers dissolve in water and include barley, cereal grains, cornmeal, and oats.

Table 45.1 - Mechanisms for Intestinal Absorption of Nutrients

-Active transport- An energy-dependent process whereby particles move from an area of greater concentration to an area of lesser concentration. A special "carrier" moves the particle across the cell membrane. -Passive diffusion- The force by which particles move outward from an area of greater concentration to one of lesser concentration. The particles do not need a special "carrier" to move outward in all directions. -Osmosis- Movement of water through a semipermeable membrane that separates solutions of different concentrations. Waters moves to equalize the concentration pressures on both sides of the membrane. -Pinocytosis- Engulfing of large molecules of nutrients by the absorbing cell when the molecule attaches to the absorbing cell membrane.

High Fiber diet

-Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits

Soft/Low Residue diet

-Addition of low-fiber, easily digested foods, such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables, desserts, cakes, and cookies without coconut or nuts

Indispensable amino acids

-Body does not synthesize, we need these provided in our diet, ex: histidine, lysine, and phenylanine.

BOX 45.2 - 2015-2020 Dietary Guidelines for Americans: Key Recommendations for the General Population

-Adopt a healthy eating pattern at an appropriate calorie level with a variety of nutrient-dense foods and beverages among all the food groups. -Maintain body weight in a healthy range. -Encourage physical activity and decrease sedentary activities. -Encourage fruits, vegetables, whole-grain products, seafood, and fat-free or low-fat milk. -Eat a variety of proteins, including lean meats, seafood, poultry, eggs, legumes, nuts, seeds and soy products. -Limit saturated fats and trans fats, consuming less than 10% of calories per day from saturated fats. -Limit added sugar or sweeteners so that less than 10% of calories comes from added sugars. -Consume less than 2300 milligrams of sodium per day. -Choose and prepare foods with little salt, and eat potassium-rich foods. -Limit intake of alcohol to moderate use (i.e., one drink daily for women and two drinks daily for men). -Practice food safety to prevent bacterial foodborne illness. Use food safety principles of Clean, Separate, Cook, and Chill.

BOX 45.4 - Focus on Older Adults - Factors Affecting Nutritional Status

-Age-related GI changes that affect digestion of food and maintenance of nutrition include changes in the teeth and gums, reduced saliva production, atrophy of oral mucosal epithelial cells, increased taste threshold, decreased thirst sensation, reduced gag reflex, and decreased esophageal and colonic peristalsis. -The presence of chronic illnesses (e.g., diabetes mellitus, end-stage renal disease, cancer) often affects nutrition intake. -Adequate nutrition in older adults is affected by multiple causes such as lifelong eating habits, culture, socialization, income, educational level, physical functional level to meet ADLs, loss, dentition, and transportation. -Adverse effects of medications cause problems such as anorexia, GI bleeding, xerostomia, early satiety, and impaired smell and taste perception. -Cognitive impairments such as delirium, dementia, and depression affect ability to obtain, prepare, and eat healthy foods.

Labs for nutritional status

-Albumin -Pre-albumin -Blood glucose -Lipid profile -Electrolytes -Hemoglobin -Hematocrit

TABLE 45.3 Religious Dietary Restrictions - Mormons

-Alcohol, Tobacco, Caffeine such as teas, coffees, or sodas

TABLE 45.3 Religious Dietary Restrictions - Hinduism

-All meats, Fish and shellfish with some restrictions, Alcohol

Anorexia nervosa

-An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being overweight

Bulimia nervosa

-An eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

Macrominerals

-Any of the minerals that people require daily in amounts over 100 mg

TABLE 45.5 Food Safety

-Botulism- -Escherichia coli (E. coli)- -Listeriosis- -Perfringens enteritis- -Salmonellosis- -Shigellosis- -Staphylococcus-

Catabolism

-Breakdown of biochemical substances into simpler substances and occurs during physiological states of negative nitrogen balance

Anabolism

-Building of more complex biochemical substances by synthesis of nutrients

List nutrients

-Carbohydrates -Fats (Lipids) -Protein -Vitamins -Water -Minerals

Ketones

-Chemicals your liver makes -You produce them when you don't have enough insulin in your body to turn glucose into energy -You need another source, so your body uses fat instead -Your liver turns this fat into ketones, a type of acid, and sends them into the blood stream

Triglycerides

-Circulate in the blood and are composed of three fatty acids attached to a glycerol -Composed of chains of carbon and hydrogen atoms with an acid group on one end of the chain and a methyl group at the other -Can be saturated or unsaturated

Simple carbohydrate

-Classification of both monosaccharides and disaccharides; they are found primarily in sugars

Dysphagia Stages, Thickened Liquids, Pureed Diet

-Clear and full liquid in addition to scrambled eggs, pureed meats, vegetables and fruits pureed, mashed potatoes and gravy

Clear liquid diet

-Clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, popsicles

Full liquid diet

-Clear liquid diet in addition to smooth textured dairy products, , strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt

Mechanical Soft diet

-Clear liquid, full liquid, and pureed with addition to all cream soups, ground meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)

TABLE 45.8 Metabolic Complications of Parenteral Nutrition

-Electrolyte imbalance -Hypercapnia -Hyperglycemia -Hyperglycemic hyperosmolar nonketotic coma or Hyperosmolar hyperglycemic nonketotic syndrome

Nutrients

-Elements necessary for the normal function of numerous body processes

Gluten free diet

-Eliminates wheat, oats, rye, barley and their derivatives

Basal metabolic rate (BMR)

-Energy needed at rest to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature) for a specific amount of time

Correctly perform the procedure for initiation and management of enteral feedings.

-Enteral feedings are for patients who are unable to ingest food but who have a functioning GI tract.

DietaryReferenceIntakes(DRIs)

-Evidence-based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age-group

Parenteral nutrition (PN)

-Form of specialized nutrition support in which nutrients are provided intravenously

TABLE 45.4 Physical Signs of Nutritional Status

-General appearance- easily fatigued, no energy -Weight- overweight, obese, or underweight -Posture- poor posture -Muscles- weak, poor tone -Mental status- inattentive, irritable, confused -Neurological function- burning/tingling of hands and feet, loss of position and vibratory sense, decrease or loss of ankle and knee reflexes -GI function- anorexia, indigestion, constipation or diarrhea, abdominal distention -Cardiovascular function- tachycardia, elevated BP -Hair- stringy, dull, brittle, dry, thin and sparse -Skin(general)- rough, dry, scaly, pale, pigmented, irritated, bruises -Face and neck- swollen, skin dark over cheeks and under eyes -Lips- dry, scaly, swollen; redness and swelling at the corners of the mouth; lesions at corner of mouth -Mouth- swollen, oral lesions -Gums- spongy, inflamed, bleeds easily -Tongue- swelling, scarlet and raw, magenta color -Teeth- missing or broken teeth -Eyes- pale, redness, dryness, or infection -Nails- spoon-shaped, brittle, ridged -Legs and feet- edema, tender, tingling, weakness -Skeleton- bowlegs, knock-knees, chest deformity at diaphragm, beaded ribs, prominent scapulas

List the current dietary guidelines for the general population.

-Guidelines for dietary change recommend reduced fat, saturated fats, sodium, refined sugar, and cholesterol and increased intake of complex carbohydrates and fiber.

Insulin

-Hormone made by the islet cells of the pancreas -Controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy

Discuss major methods of nutritional assessment.

-Improper nutrition impacts all body systems; nutritional assessment includes a review of physical assessment.

Explain the effects of a well-balanced diet on the body throughout the life span.

-Ingestion of a diet balanced with carbohydrates, fats, proteins, and vitamins and minerals provides the essential nutrients to carry out the normal physiological functioning of the body across the lifespan.

Minerals

-Inorganic elements essential to the body as catalysts in biochemical reactions

Peristalsis

-Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.

Discuss medical nutrition therapy in relation to medical conditions.

-MNT is a recognized treatment modality for both acute and chronic disease states.

Figure 45.1 - Summary of digestive system anatomy/organ function

-MOUTH- breaks up food particles, Salivary glands- saliva moistens and lubricates food, amylase digests carbohydrates -PHARYNX- swallows -ESOPHAGUS- transports food -STOMACH- stores and churns food, HCI activates enzymes/breaks up food/kills germs, mucus protects stomach wall, limited absorption -SMALL INTESTINE- completes digestion, mucus protects gut wall, absorbs nutrients and most water -LARGE INTESTINE- reabsorbs some water/ions/vitamins, forms and stores feces -RECTUM- stores and expels feces -ANUS- opening for elimination of feces -GALLLADDER- stores and concentrates bile -LIVER- breaks down and builds up many biological molecules, stores vitamins and iron, destroys old blood cells, destroys poisons, produces bile to aid in digestion -PANCREAS- hormones regulate blood glucose levels, bicarbonates neutralize stomach acid

BOX 45.7 Causes of Dysphagia

-Myogenic- myasthenia gravis, aging, muscular dystrophy, polymyositis -Neurogenic- stroke, cerebral palsy, guillain-barre syndrome, multiple sclerosis, amyotrophic lateral sclerosis, diabetic neuropathy, parkinson's disease -Obstructive- benign peptic structure, lower esophageal ring, candidiasis, head and neck cancer, inflammatory masses, trauma/surgical resection, anterior mediastinal masses, cervical spondylosis -Other- GI or esophageal resection, rheumatological disorders, connective tissue disorders, vagotomy

Therapeutic Diets

-NPO-withholding foods -Clear liquid -Full liquid -Dysphagia -Mechanical soft -Soft -Diet as tolerated -Restrictive

Low cholesterol diet

-No more than 300 mg/day of dietary cholesterol

Regular diet

-No restrictions unless specified

Indications for Parenteral Nutrition - BOX 45.11

-Nonfunctional GI tract -Extended bowel rest -Preoperative total parenteral nutrition -Severely catabolic patients when GI tract not usable for more than 4-5 days

Trace elements

-Required by an organism in only minute quantities

Resting energy expenditure (REE)

-aka-resting metabolic rate, the amount of energy you need to consume over a 24-hour period for your body to maintain all of its internal working activities while at rest

Explain the nursing management of enteral feedings.

-One of the most important responsibilities of a nurse administering enteral feedings is to take precautions to prevent patients from aspirating the feeding.

Vitamins

-Organic substances present in small amounts in foods that are essential to normal metabolism

Explain the variance in nutritional requirements throughout the lifespan.

-Patients with alterations in chewing and swallowing are at risk for aspiration.

TABLE 45.3 Religious Dietary Restrictions - Muslim

-Pork, Alcohol, Caffeine, Ramadan fasting sunrise to sunset for a month, Ritualized methods of animal slaughter required to meet ingestion

TABLE 45.3 Religious Dietary Restrictions - Judaism

-Pork, Predatory fowl, Shellfish (eat only fish with scales), Rare meats, Blood (e.g., blood sausage), Mixing of milk or dairy products with meat dishes, Must adhere to kosher food preparation methods, 24 hours of fasting on Yom Kippur, No leavened bread eaten during Passover, No cooking on the Sabbath from sundown Friday to sundown Saturday

TABLE 45.3 Religious Dietary Restrictions - Seventh Day Adventists

-Pork, Shellfish, Fish, Alcohol, Caffeine, Vegetarian or ovolactovegetarian diets encouraged

Enteral nutrition (EN)

-Provision of nutrients through the gastrointestinal tract when the client cannot ingest, chew, or swallow food but can digest and absorb nutrients.

TABLE 45.7 Enteral Tube Feeding Complications

-Pulmonary aspiration -Diarrhea -Constipation -Tube occlusion -Tube displacement -Abdominal cramping, nausea/vomiting -Delayed gastric emptying -Serum electrolyte imbalance -Fluid overload -Hyperosmolar dehydration

BOX 45.3 - Diagnostic Criteria for Eating Disorders - Bulimia Nervosa

-Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time) -A feeling of lack of control over eating behavior during eating binges -Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise -Binge eating and inappropriate compensatory behaviors that both occur, on average, at least once a week for 3 months -Self-evaluation unduly influenced by body shape and weight

Metabolism

-Refers to all biochemical reactions within the cells of the body

Nutrient density

-Refers to the proportion of essential nutrients to the number of kcals

BOX 45.3 - Diagnostic Criteria for Eating Disorders - Anorexia Nervosa

-Restriction of energy intake relative to requirements, leading to a significantly low body weight in relation to age, sex, development trajectory, and physical health -Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight -Disturbance in the way in which one's body weight, size, or shape is experienced; undue influence of body weight or shape on self-evaluation; or persistent lack of recognition of the seriousness of the current low body weight (e.g., the person claims to "feel fat" even when emaciated, believes that one area of the body is "too fat" even when obviously underweight

Hypervitaminosis

-Results from mega-doses of supplemental vitamins, excessive amounts in fortified food, and large intake of fish oils

TABLE 45.3 Religious Dietary Restrictions - Christianity

-Some faiths such as Baptists have minimal or no alcohol, Some meatless days may be observed during the calendar year, commonly during Lent

Intravenous fat emulsions

-Sometimes added to PN to provide supplemental kilocalories, prevent essential fatty acid deficiencies, and help control hyperglycemia during periods of stress

-Discuss how to implement diet counseling and patient teaching in relation to a patient's expectations.

-Special diets alter the composition, texture, digestibility, and residue of foods to suit the patients needs.

Anthropometry

-Systemic method of measuring the size and makeup of the body

Explain the ChooseMyPlate and discuss its value in planning meals for healthy nutrition.

-The ChooseMyPlate program provides guidelines for a heart-healthy lifestyle.

Daily values

-The US FDA created daily values for food labels in response to the 1990 Nutrition Labeling and Education Act (NLEA). The FDA first established two sets of reference values. The referenced daily intakes (RDIs) are the first set, comprising proteins, vitamins, and minerals based on the RDA. The daily reference values (DRVs) make up the second set and consist of nutrients such as total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium. Combined, both sets make up the daily values used on food labels. Daily values did not replace RDAs but provided a separate, more understandable format for the public. Daily values are based on percentages of a diet consisting of 2000 kcal/day for adults and children 4 years or older.

Nitrogen balance

-The amount of nitrogen consumed as compared with the amount of nitrogen excreted in a given period of time -Achieving nitrogen balance means that the intake and output of nitrogen are equal.

Dispensable amino acids

-The body synthesizes these

Albumin

-The main protein in human blood, the key to regulating osmotic pressure of blood -Soluble in water, precipitated by acid, and coagulated by heat

Critique the approaches for how to avoid complications of parenteral nutrition.

-The most important responsibility of the nurse monitoring parenteral nutrition is to take precautions to prevents patients from developing a catheter-related infection, hyperglycemia, or fluid overload.

Ideal body weight (IBW)

-The optimal weight recommended for optimal health

Food security

-This term means all household members have access to sufficient, safe, and nutritious food to maintain a health lifestyle.

Discuss the process of digestion and absorption.

-Through digestion food is broken down into its simplest for absorption. Digestion and absorption occur mainly in the small intestine.

Medical nutrition therapy (MNT)

-Use of specific nutritional therapies to treat an illness, injury, or condition

Diabetic diet

-Used for patients with diabetes mellitus -Balanced intake of carbohydrates, fats, and proteins, varies in caloric recommendation

Indications for Enteral Nutrition - BOX 45.11

-Used with patients who have a functional GI tract -Cancer, critical illness/trauma, neurological and muscular disorders, GI disorders, respiratory failure with prolonged intubation, inadequate oral intake

Low sodium diet

-Vary from no-added-salt to severe sodium restriction

Water-soluble vitamins

-Vitamin C and B complex -Body does not store these -Absorb easily in the GI tract

Chyme

-When food is an acidic, liquefied mass -Flows into the duodenum and quickly mixes with bile, intestinal juices, and pancreatic secretions

Kilocalories (kcal)

-When the kcal of the food we eat meet our energy requirements, our weight does not change. When the kcal ingested exceed our energy demands, we gain weight. Likewise, if kcal ingested fail to meet our energy requirements, we lose weight.