ATI Nutrition Chapter 2

MEDICAL CONDITIONS affecting metabolic rate that INCREASE BMR (1-4):

Cardiac failure Burns Surgery/wound healing HIV/AIDS

Digestion

A systemic process that includes the breakdown and absorption of nutrients.

What are the effects of acute stress on metabolism (3)?

Acute stress causes an increase in metabolism, blood glucose levels, and protein catabolism. A major nutritional concern during acute stress is protein deficiency as stress hormones break down protein at a very rapid rate. Protein requirements can be increased to more than 2g/kg of body weight, or up to 25% of total calories, depending on the client's age and prior nutritional status.

Strategies to increase protein and caloric content (1-3):

Add skim milk powder to milk (double-strength milk). Use whole milk instead of water in recipes. Add cheese, peanut butter, chopped hard-boiled eggs, or yogurt to foods.

Metabolic rate considerations (4-5):

Any catabolic illness (surgery, extensive burns) increases the body's requirement for calories to meet the demands of an increased BMR. Disease and sepsis also increase metabolic demands and can lead to starvation/death.

Metabolic rate considerations (1-3):

Basal metabolic rate (BMR) is affected by lean body mass and hormones. Body surface area, age, and sex are also factors that contribute to BMR. In general, males have a higher metabolic rate than females due to their higher amount of body muscle and decreased amount of fat. Thyroid function tests can be used as an indirect measure of BMR.

Basal Metabolic Rate (BMR)

Basal metabolic rate (BMR), also called basal energy expenditure (BEE), refers to the amount of energy used in 24 hr for INVOLUNTARY activities of the body (maintaining body temperature, heartbeat, circulation, and respirations). This rate is determined while at rest, and following a 12-hr fast.

What do energy nutrients provide when metabolized?

Carbon dioxide Water Adenosine triphosphate (ATP)

Strategies to increase protein and caloric content (4-5):

Dip meats in eggs or milk and coat with bread crumbs before cooking. Nuts and dried beans are significant sources of protein. These are good alternatives for a dairy allergy or lactose intolerance.

MEDICATIONS affecting metabolic rate that INCREASE BMR (3):

Epinephrine Levothyroxine Ephedrine sulfate

MEDICAL CONDITIONS affecting metabolic rate that INCREASE BMR (1-4):

Fever Involuntary muscle tremors (shivering, Parkinson's) Hyperthyroidism Cancer

How are excess energy nutrients stored?

Glucose is converted to glycogen and stores in the liver and muscle tissue. Surplus glucose is converted to fat. Glycerol and fatty acids are reassembled into triglycerides and stored in adipose tissue. Amino acids make body proteins.

MEDICAL CONDITIONS affecting metabolic rate that DECREASE BMR (1):

Hypothyroidism

What data is collected during an assessment related to metabolism (5-7)?

Lab values: albumin, transferrin, glucose, creatinine Clinical findings of malnutrition: pitting edema, hair loss, wasted appearance. Medication adverse effects that can affect nutrition.

Factors affecting metabolic rate that INCREASE BMR (1-4):

Lean, muscular body build Exposure to extreme temperatures Prolonged stress Rapid growth periods (infancy, puberty)

What is metabolic rate?

Metabolic rate refers to the speed at which food energy is burned.

Nursing interventions for ingestion, digestion, absorption, and metabolism (4):

Monitor food intake and monitor fluid intake and output. Use client-centered approach to address disease-specific problems with ingestion, digestion, or medication regime. Collaborate with dietitian. Provide adequate calories and high-quality protein.

Negative nitrogen balance

Negative nitrogen balance indicates that the excretion of nitrogen exceeds intake. The individual is receiving insufficient protein, and the body is breaking down more tissue than it is building. This is seen during periods of illness, trauma, aging, and malnutrition.

Nitrogen balance

Nitrogen balance refers to the difference between the daily intake and excretion of nitrogen.It is also an indicator of tissue integrity. A healthy adult experiencing a stable weight is in nitrogen equilibrium, also known as neutral nitrogen balance.

Absorption

Occurs as components of nutrients pass through the digestive system into the bloodstream and lymphatic system.

MEDICATIONS affecting metabolic rate that DECREASE BMR (3):

Opioids Muscle relaxants Barbiturates

Positive nitrogen balance

Positive nitrogen balance indicates that the intake of nitrogen exceeds excretion. Specifically, the body builds more tissue than it breaks down. This normally occurs during periods of growth: infancy, childhood, adolescence, pregnancy, and lactation.

Factors affecting metabolic rate that INCREASE BMR (5-7):

Pregnancy Lactation Physical conditioning

What are the complications associated with protein deficiency?

Protein deficiency increases the risk of complications from severe trauma or critical illness (skin breakdown, delayed wound healing, infections, organ failure, ulcers, impaired medication tolerance).

Resting Metabolic Rate (RMR)

Resting metabolic rate (RMR), also called resting energy expenditure (REE), refers to the calories needed for INVOLUNTARY activities of the body at rest. This rate does not consider the 12-hr fast criteria.

Factors affecting metabolic rate that DECREASE BMR (3):

Short, overweight body build Starvation/malnutrition Age-related loss of lean body masses

What is the order of energy usage by the body?

The body cells first use available ATP for growth and repair, then use glycogen and stored fat.

Catabolism

The breaking down of substances with the resultant release of energy.

What is the function of the liver in metabolism?

The liver stores glucose in the form of glycogen. The liver removes nitrogen from amino acids, and the remaining product is converted to glucose or fat for energy.

Ingestion

The process of consuming food by the mouth, and moving it through the digestive system.

Metabolism

The sum of all chemical processes that occur on a cellular level to maintain homeostasis. Metabolism is comprised of catabolism and anabolism.

Anabolism

The use of energy to build or repair substances.

What data is collected during an assessment related to ingestion, digestion, absorption, and metabolism (8-10)?

Usual 24-hr dietary intake. Use of nutritional supplements, herbal supplements, vitamins, and minerals. Use of alcohol, caffeine, and nicotine.

What data is collected during an assessment related to metabolism (1-4)?

Weight and history of recent weight patterns. Medical history for diseases that affect metabolism and nitrogen balance. Extent of traumatic injuries, as appropriate. Fluid and electrolyte status.