Ch. 26 Nutrition

Copper

Aid in iron metabolism, works with many enzymes in protein metabolism and hormone synthesis

Magnesium

Aids thyroid hormone secretion, maintains basal metabolic rate, activates enzymes for carb and protein metabolism, nerve and muscle function, cardiac function

Vitamin E

Antioxidant, protects red blood cells and muscle tissue cells

Proteins

Are complex molecules made up of amino acids. Essential proteins are not made in the body while nonessential ones are. Complete proteins are foods that have all the amino acids (animal products) while incomplete proteins do not like vegetables products, two vegetable products can be combined to make a complete protein Protein. Amonia (NH3) is the result of catabolized amino acids and the nitrogen-containing part. amonia is excreted in the urine as urea. Nitrogen balance occurs when intake and output of nitrogen are equal Positive nitrogen balance: exists when nitrogen intake exceeds output, making a pool of amino acids available for growth, pregnancy, and tissue maintenance/repair Negative nitrogen balance: exists when nitrogen intake is lower than nitrogen loss due to injury, malnutrition Functions of protein: tissue building, metabolism, immune system function, fluid balance, acid-base balance, secondary energy source

Lipids

Are organic (carbon-containing) substances that are insoluble in water. Made up of carbon, hydrogen, and oxygen. Lipids that are solid at room temperature are called fats, while those liquid at room temp. oils. Foods contains 3 types of lipids: glycerides, sterols, and phospholipids. Functions of lipids: supply essential nutrients, energy source, flavor and satiety, provide insulation, protect vital organs, thermoregulation, and enables accurate nerve-impulse transmission, cell metabolism and cholesterol function

Carbohydrates

Are the primary source of nutrients for the body. There simple one (monosaccharides, disaccharides) and complex carbs (polysaccharides exp. dietary fiber). Carbs supply energy for muscle and organ function, spare protein, enhance insulin secretion, increase satiety, and improve absorption of sodium and excretion of calcium

Vitamin K

Blood clotting, bone development

Phosphorus

Bone and tooth strength, overall metabolism, formation of enzymes, acid-base balance

Calcium

Bone, teeth formation, blood clotting, nerve conduction, muscle contration, cellular metabolism, heart action

Macrominerals

Calcium, Magnesium, phosphorus, Potassium, and sodium

Pantothenic acid

Cell metabolism of fat and cholesterol, amino acid activation, heme formation

Thiamin

Cellular metabolism (energy from glucose, storing energy as fat), nervous system function, GI system function, CV system function

Niacin

Cellular metabolism to produce energy

Riboflavin

Cellular metabolism, antioxidant, tissue health and growth

Folacin (folate, folic acid)

Cellular metabolism, neurotransmitter synthesis, cell division, DNA SYNTHESIS, hemoglobin, synthesis

Zinc

Cofactor for many enzymes involved in growth, insulin storage immunity, alcohol metabolism, sexual development and reproduction

Vitamin C

Collagen synthesis, "cementing" substance for capillary walls, antioxidant, iron absorption, immune function

Trace minerals

Copper, fluoride, iodine, iron, zinc

Describe tools and techniques for gathering subjective data about nutritional status

Cursory screening: consists of evaluation of height weight, and body mass Index (BMI) coupled with a brief dietary history, those found at risk are further evaluated. The subjective global assessment: commonly used screening method makes use of info from overall medical history and physical exam to evaluate a client's nutritional status The nutrition Screening initiative (NSI): developed for older adults, identifies indicators of impaired nutritional status The mini nutritional assessment: also for older adults can be used with clients of all ages Nutritional Screening for older adults with dementia

Describe nursing interventions for patients with special needs

For patients who are NPO, IV fluids provide small amounts of glucose, provide assist with oral hygiene, if allowed provide ice chips, hard candy, gum or sips of water to rinse mouth. Make sure visitors do not eat around patient and have patient do other activities during mealtime For Nauseated patients: assess cause for nausea and providing comfort and preventin measures For older adults: assist with meals, stimulate patient's appetite, teach patient to buy nutritious foods on a limited diet, for nutritional deficiencies clients must eat nutrient dense foods first, for gastroesophageal reflux disease advise patient to not eat close to bedtime and to elevate the bed, avoid overeating, bending over, fruit juices, fatty foods, alcohol, smoking. For dry mouth: age-associated, have clients avoid caffeine, alcohol, tobacco, dry, bulky, salty foods. Offer sugarless candy/gum (unless pt suffers from dementia). Use lip moisturizer and encourage frequent sips of water. For glucose intolerance: avoid sugars unless relieving hypoglycemia, include complex carbs. For decreased abdominal peristalsis: include lots of water and fiber and exercise. For avoiding dementia: eat healthy, omega-3. For treatments that require NPO, try scheduling them early in the morning or if it's later in the day ask the doctor if patient can have an early breakfast.

Fluoride

Increases resistance to dental caries

Identify the primary nutritional considerations for various developmental stages

Infants to 1 year: nutritional needs per unit of body weight are greater than any other time, calories and protein (brain development), vitamins and minerals (iron, calcium, vitamins C & D), fluids about 1.5 to 2 oz of breast milk/formula per pound of body weight daily Toddlers and preschoolers: 900-1800 Kcal and 1250 ml of fluid per day (based on body weight) between 2 and 5 years of age fat intake should be about 50% School-Age children: 2400 and 1750 ml of fluid daily. adequate nutrition. 32 % overweight, 16 % and 11 % extremely obese Adolescent: Muscle build in boys, fat deposit in girls, bad eating habits, mostly girls are concerned with body image and dieting, parents need to keep nutritious foods at home Adults: require adequate amounts of protein, vitamins, and minerals esp. calcium, vitamin D, folic acid, iron. Women of childbearing age need to take 0.4 to 0.8 mg of folic acid daily, chronic diseases start appearing including obesity. Older adults: Needs vary slightly from middle adulthood. They need fewer calories. They still need the same or higher levels of nutrients. They lose interest in eating an thirst sensation decrease those with chronic diseases may need low salt, sugar or fat diets, taste and smell also decline with age, vision and hearing decline, the inability to go the store because they cannot drive all contribute to poor eating habits for the elderly Adult failure to thrive: complex disorder in many institutionalized older adults characterized by weight loss, decreased activity and interaction, and increased frailty Pregnant and lactating women: Nutritional requirements increase dramatically, folic acid is critical in the first trimester 13 weeks to prevent neural tube defects (0.6 to 0.8 mg), protein, calcium for muscle, brain, or bone tissue. Iron for fetal blood supplies. They need about 300 more calories per day in second and 3rd trimesters. Breastfeeding requires 500 more calories per day, increased fluid

Potassium

Intracellular fluid control, acid-base balance, nerve transmission, muscle contraction, glycogen formation, protein synthesis, energy metabolism, BP regulation

List physical assessment findings and lab values that indicate nutritional status

Malnutrition: impaired development or functions caused by a long-term deficiency, excess, or imbalance in energy and or nutrient intake. Kwashiorkor: deficiency of protein in a diet that is primarily startches Marasmus: low caloric intake happens mostly in children, undernourished people are prone to infections. Symptoms of not eating enough include: reduced physical activity, weight loss, and reduced height, abdominal enlargement, and hair loss Vitamin or mineral deficiency diseases: beriberi (neurological deficit), scurvy (delayed wound healing/poor bone growth), and pellagra (diarrhea and dementia) Lab values: serum albumin level 3.5 g/dl or less, glucose, albumin, prealbumin, transferrin, BUN, creatinine, lymphocytes, hemoglobin, globulin

Vitamin A

Night and color vision, cellular growth and maturity, healthy skin and mucous membranes, growth of skeletal and soft tissues, reproduction

Identify the types, functions, metabolism, and major food sources, nutrients, vitamins, minerals, water

Nutrients are building blocks that the cells and tissues of the body depend on for their function, they include: carbs, protein, lipids, sodium, vitamins, and minerals Carbs, proteins, and lipids supply the body with energy and they are macronutrients; vitamins and minerals are micronutrients

Vitamins

Organic substances necessary for metabolism and preventing a particular deficiency, are not made by the body, they help maintain body tissues support immune system, and ensure healthy vision Fat-soluble vitamins: A, D, E, K Water-soluble vitamins: C, B-complex: thiamine, riboflavin, niacin, pyridoxine (vitamin B6), folic acid, panthothenic acid, biotin, and cyanocobalamin.

B6 (Pyrodoxine)

Protein, some carbs metabolism, RBC production, neurotransmitter synthesis

Vitamin D

Regulates blood calcium levels, regulates rate of deposit and resorption of calcium in bone

Iron

Synthesis of hemoglobin, general metabolism (e.g. of glucose), antibody production, drug detoxification in the liver

Iodine

Synthesis of the thyroid hormone, thyroxine

Differentiate among reliable sources that provide nutritional information

USDA dietary, guidelines, My Pyramid, Pyramid for activity, and Pyramid for older adults, and Canada's food guide to healthy eating

Sodium

Water balance, acid-base balance, muscle action, nerve transmission, convulsions

Calculate a Basal metabolic index (BMI)

Weight in kg/ (height in meters)2; 1 meter = 39.37 in

Water

is 55-65% weight of man and 50-55% weight of women. 40 % of water in intracellular fluid and 20% is extracellular fluid. Water is used as a: solvent, transportation, body structure and form, and temperature