Unit 4-C Nutrition

Macrominerals

(bulk minerals- needed by the body in amts. greater than 100mg/day) include calcium, phosphorus, sulfur, sodium, chloride, potassium, and magnesium.

BMI

A person with a BMI below 18.5 is underweight, a BMI of 18.5 to 24.9 is a healthy person, a BMI of 25 to 29.9 indicates an overweight person, a BMI of 30 or greater indicates obesity and a BMI of 40 or greater indicates extreme obesity.

megadoses of nutrient supplements

Because some nutrients compete against each other for absorption, an excess of one nutrient can lead to a deficiency of another. dietary supplements can have drug-like effects and may interact with food and medication.

alcohol abuse

alcohol can alter the body's use of nutrients, and thereby its nutrient requirements. the toxic affect of alcohol on the intestinal mucosa interferes with normal nutrient absorption; thus requirements increase as the efficiency of absorption decreases.

nutritional screening

an important part of the nursing assessment. screening looks for cues associated with nutrition problems to determine if a person is malnourished or at risk for malnutrition. the mini nutritional assessment (MNA) is an example of a screening tool used to detect older adults at risk for malnutrition before changes in the albumin level and the BMI.

Factors affecting Nutrition

developmental considerations-throughout the life cycle, nutrient needs change in relation to growth, development, activity, and age-related changes in metabolism and body composition. periods of intense growth and development, such as during infancy, adolescence, pregnancy, and lactation, cause an increase in nutrient needs. age also influences food intake.

religion

dietary restrictions associated with religions might affect a patient's nutritional requirements. many religions eschew certain types of food products. mormans do not use coffee, tea, or alcohol. Hindus do not eat beef.

fat functions

fat digestion occurs largely in the small intestine. fats are the most concentrated source of energy in the diet, providing 9 calories for every gram. fat intake should be no more than 20% to 35% of total caloric intake, with less than 10% of fat calories from saturated fats and less than 300 mg/day of cholesterol.

cholesterol

fatlike substance found only in animal products. It is not an essential nutrient b/c the body produces sufficient amts. serves many important functions in the body, but high serum levels are clearly associated with increased risk for atherosclerosis.

Fats

fats in the diet are insoluble in water and, therefore, insoluble in blood. they are composed of carbon, hydrogen, and oxygen. 95% of the lipids in the diet are in the form of triglycerides. Saturated fats contains more hydrogen than unsaturated fats. most animal fats are considered to be saturated and vegetable fats are unsaturated. when manufacturers partially hydrogenate liquid oils, they become more solid and stable. the substance is called trans fat

meaning of food

food means different things to different people. in addition to satisfying hunger and providing nutrition, food may signify a celebration, a social gathering, or a reward.

digestion

foods consumed by a person provides necessary nutrients needed for cells to perform their necessary functions, but cells cannot use foods in their consumed form. the GI system breaks food down into small particles that can pass into the cells and be used by the cells. this is called digestion. peristalsis moves the food through the esophagus and into the stomach. the food leaves the stomach and enters the small intestines. absorption takes place in the small intestines. undigested waste materials continue through the GI system and are eliminated.

wellness diagnosis

for pts. who are incorporating sound nutritional practices in their daily routine, the following wellness diagnosis may be appropriate: readiness for enhanced nutrition associated with food safety.

teaching nutritional information

for the greatest chance of success, tailor diet instructions individually to the patient's lifestyle, culture, intellectual ability, and level of motivation. include information about food safety issues in patient teaching. this includes safe-handling of foods, food storage, and preventing food-borne illness.

food frequency record

gives a general picture of nutritional consumption. ask pt. questions to elicit an average number of times certain foods or food groups are consumed in a given period of time. Ex.- ask "how many times in the last week have you eaten fish?"

fat-soluble vitamins

include vitamin A, D, E, & K. They are absorbed with fat into the lymphatic circulation. like fat, they must be attached to a protein to be transported through the blood. the body stores excess of the fat-soluble vitamins, therefore daily intake is not imperative and deficiency symptoms may take weeks, months, or years to develop. excessive intake, particularly vitamin A & D is toxic.

water-soluble vitamins

include vitamin C & B complex vitamins; they are absorbed through intestinal wall directly into the bloodstream. they are usually not stored in the body, therefore a daily intake is recommended. amts. consumed in excess are excreted in urine. toxicities are not likely.

Minerals

inorganic elements found in all body fluids and tissues in the form of salts or combined with organic compounds. some minerals function to provide structure within the body, while others help to regulate the body processes. minerals, which are elements, are not broken down in the body, but rather contained in the ash that remains after digestion.

biochemical data

laboratory tests, which measures blood and urine levels of nutrients or biochemical functions that depend on an adequate supply of nutrients, can objectively detect nutritional problems in their early stages. most routine biochemical tests measure protein status; measures of body vitamin, mineral and trace element status are also available. protein status can be determined by measuring serum albumin and transferrin levels and by a total lymphocyte count. serum albumin levels are a good indicator of a patient's nutritional status and can identify chronic nutrition problems.

monitoring nutritional status

malnourished pts. are more likely to have slower wound healing and to develop complications. preventing malnutrition can have a positive effect on patient outcomes.

Assessing dietary recall

many different methods can be used to assess actual dietary intake

medication

many drugs have the potential to influence nutrient requirements. nutrient absorption may be altered by drugs that change the pH of the GI tract, increase GI motility, damage the intestinal mucosa or bind with nutrients rendering them unavailable to the body.

Increased food intake

may lead to obesity. excess weight increases the risk for numerous medical problems; increases the risks associated with surgery; increases the risk for complications during pregnancy, labor, and delivery.

Waist Circumference

measured by placing a measuring tape snugly around the patient's waist at the level of the umbilicus. This measurement is a food indicator of abdominal fat. Where excess body fat is deposited is thought to be am important and reliable indicator of risk for disease. The risk increases with a waist circumference of 40 in men and 35 in women.

gender

men differ from women in their nutrient requirements due to differences in body composition and reproductive function. they have higher caloric and protein requirements due to their larger muscle mass.

nursing interventions

nutrition management weight management nutritional counseling nutritional monitoring

culture

nutritional diversity Is common among cultural or ethnic groups. culture influences what is eaten or considered edible, how its prepared, and what combinations of food are permitted.

Nutrients

of the six classes of nutrients, three supply energy (carbohydrates, protein, lipids) and three are needed to regulate body processes (vitamins, minerals, and water).

Vitamins

organic compounds needed by the body in small amounts. they do not provide energy but are needed for the metabolism of carbs, protein, and fats. vitamins are essential in the diet b/c most are not synthesized in the body or are made in insufficient amts. vitamins are classified as either water-soluble or fat-soluble.

patient outcomes

patient will: -attain and maintain ideal body weight, as indicated by BMI and waist circumference. -eat a variety of food in each of three or more meals -eat a diet adequate but not excessive, in all nutrients, based on the myplate food guideline system, the DRIs, and dietary recommendations and guidelines issued from health and U.S. governmental agencies.

assessing

the nutritional assessment is a systematic approach used to identify the patient's actual and potential needs, formulate a plan to meet those needs, initiate the plan or assign others to implement it, and evaluate the effectiveness of the plan. nutritional assessment is appropriate for all patients.

Nutrition

the study of how food nourishes the body. It encompasses the study of nutrients and how they are handled by the body as well as the impact of human behavior and environment on the process of nourishment.

Microminerals

trace elements- minerals needed by the body in amts. less than 100mg/day. microminerals that have recommended dietary intake established include iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine.

Body Weight Standards

Ideal body weight or healthy body weight is an estimate of optimal weight for optimal health. a general guideline determines ideal weight based on height. The more preferred methods to establish ideal body weight include body mass index (BMI) for adults and children and measurement of waist circumference for adults only.

imbalanced nutrition as the etiology

-ineffective health maintenance related to lack of knowledge about adequate nutrition. -constipation related to inadequate fluid or fiber intake -deficient fluid volume related to inadequate fluid intake -risk for infection related to inadequate caloric intake, inadequate protein intake

Caloric Requirements

Estimate the basal metabolic rate or the amount of calories necessary to maintain the body at rest. Multiply healthy weight (in pds.) by 10 for women and 11 for men. Estimate the total calories according to usual activity level. Choose the category that describes usual activities: 20%- sedentary (sitting, driving, sleeping, standing, etc.); 30%- Light activity (Light exercise); 40%- moderate activity (heavy housework, gardening, etc); 50%- high activity (active in physical sports or labor intensive occupation). Multiply the BMR by the percentage associated with the activity level. Ex: 1300 (BMR) X 30%= 390. 1300+390=1690 daily calories.

focus on the older adult

FOCUS ON THE OLDER ADULTNURSING STRATEGIES Nursing Strategies Altered ability to chew related to loss of teeth, ill-fitting dentures, and gingivitis •Encourage and instruct patient to care for and retain own teeth and dentures. •Encourage proper tooth brushing and use of special toothpaste if gums and teeth are sensitive. •Chop, shred, or puree foods that are difficult to chew. •Select ground meat, fish, or poultry as protein sources more easily chewed. Loss of senses of smell and taste •Serve food that is attractive and at proper temperature. •Serve one food at a time rather than mixing foods. •Serve foods with different textures and aromas. Decreased peristalsis in the esophagus •Avoid cold liquids. •Avoid emotional upsets and stress-producing situations. •Take anticholinergic drugs as ordered by physician. Gastroesophageal reflux •Avoid overeating .•Avoid juices, chocolate, and fat. •Avoid alcohol and smoking. •Elevate the head of the bed 30 to 40 degrees when sleeping. •Lose weight if necessary. •Avoid bending over. •Take antacids or other medications as ordered by physician. •Avoid eating right before bedtime. Decreased gastric secretions •Chew food thoroughly. •Eat meals on a regular schedule. •Use antacids or other medications as prescribed by physician. •Be alert for symptoms of deficiency of nutrients, particularly iron, calcium, fat, protein, and vitamin B12. Slowed intestinal peristalsis •Eat a high-fiber diet. •Remain as active as possible. •Increase fluid intake. •Avoid laxative use.•Eat meals at a regular time. •Drink prune juice or eat prunes every morning. Lowered glucose tolerance •Eat more complex carbohydrates.•Avoid sugar-rich foods. Reduction in appetite and thirst sensation •Offer fluids at regular intervals and at preferred temperature. •Be alert for symptoms of dehydration and electrolyte imbalance. •Offer small meals at frequent intervals. Nutritional deficiencies related to alcohol intake •Encourage diet high in protein and carbohydrates. •Offer small, frequent meals to maintain caloric intake. •Restrict sodium and fluids if edema is present. •Take multivitamin supplements, as ordered by physician. Loss of appetite associated with depression and loneliness •Promote mealtime as a social event. •Set an attractive table in a pleasant setting. •Eat outdoors whenever possible. •Invite guests as often as possible. •Participate in special programs for senior citizens. Physical handicaps •Open cartons and assist with setup of meal. •Arrange for home-delivered meals. •Conserve energy when preparing meals (sit on a stool, etc.).•Provide transportation and assistance to obtain food. Low income •Buy specials when available at food store. •Use generic brands. •Use coupons. •Cook larger quantities than necessary and freeze the leftovers for future use. •Substitute eggs, skim milk powder, and beans for meat. •Check for any community resources available to elderly. Malnutrition •Eat essential foods first. •Select nutrient-dense foods. •Monitor for signs of nutritional deficiencies. •Encourage eating by planning special events. Increased risk for drug-nutrient interactions •Avoid unnecessary drugs; monitor for polypharmacy. •Be aware of drug actions and interactions. •Check with pharmacist to determine if medication may or may not be taken with food. •Assess for confusion and inability to manage medication regimen.

diagnosis

Imbalanced nutrition as the problem- Imbalanced nutrition: less than body requirements (related to nothing by mouth (NPO), inadequate tube feeding, prolonged use of a clear liquid diet, nausea, vomiting, etc...) Imbalanced nutrition: more than body requirements (related to overeating, inactivity, metabolic and endocrine disorders, etc...) Risk for Imbalanced nutrition: more than body requirements (related to inappropriate eating, closely spaced pregnancies, metabolic and endocrine disorders, inappropriate use of supplements)

diet history

a more comprehensive approach to diet assessment. includes a 24-hour food recall, calorie count/food diaries, food-frequency record, as well as interview questions geared to provide information on past and present food intake and habits.

BMI

a reliable indicator of total body fat stores in the general population. the BMI does not differentiate according to gender and is calculated for adults in the following manner... BMI= weight in pounds/(height in inches) x (height in inches) x 703.

Protein

a vital component of every living cell. 22 basic building blocks known as amino acids. Although amino acids, like carbohydrates, contain carbon, hydrogen, and oxygen, they differ in that amino acids also contains nitrogen. 9 amino acids are classified as essential b/c they cannot be synthesized by the body. the remaining13 are termed non-essential (just as important) b/c the body can make them as long as a supply of nitrogen is available. Proteins are required for the formation of all body structures. animal proteins are complete and plant proteins (with the exception of soy) are incomplete.

decreased food intake

anorexia or lack of appetite, may be related systemic and local diseases. others who may have limited food intake include those who have difficulty chewing and swallowing, those who experience chronic GI problems or undergo certain surgical procedures, those with certain chronic illnesses and those with inadequate food budgets.

clinical data

assess for barriers to eating. dysphagia (difficulty swallowing or the inability to swallow) can be the result of poor dental health, cancer, or a neurologic disease, such as a stoke, Parkinson's disease, or dementia, and may reduce the patient's nutritional intake.

Energy Nutrients

carbohydrates, protein and lipids are potential sources of energy for the body.

Carbohydrates

commonly known as sugars and starches, are organic compounds composed carbon, hydrogen, and oxygen. they serve as the structural framework of plants. Relatively easy to produce and store. more easily and quickly digested than fat and protein. all carbohydrates are converted to glucose for transport through the blood or for use as energy. when the supply of glucose exceeds what is needed for energy and for maintaining serum levels, it is stored. the USDA AND DHHS recommends that carbohydrates provide 45 to 65% of total calories for adults.

Food labeling

congress passed the nutritional labeling and education act in 1990 which required all foods, including fruits and vegetables, to be clearly labeled. 4 broad categories were addressed. they included: nutrition labeling, serving serve, descriptors, health claims. Starting Jan 2006, labels were required to include information related to the amt. of trans fat on nutrition fact labels.

dietary reference intakes

provide recommended nutrient intakes for use in a variety of settings. Include: RDA (Recommended dietary allowance)-the average daily dietary intake of a nutrient that is sufficient to meet the requirement of nearly all healthy people. AI (Adequate Intake)- established when an RDA cannot be determined. based on observed intakes of the nutrient by a group of healthy people. UL (Tolerable upper intake level)- the highest daily intake of a nutrient that is likely to pose no risks of toxicity for almost all individuals. EAR (Estimated Average requirements)-the amount of a nutrient that is estimated to meet the requirement of half of all healthy people in the population. RDA, AL, UL are dietary guidelines for individuals, whereas EARs provide guidelines for groups and populations.

food diaries/calorie counts

require documentation of actual intake for a specified period of time. these tools may provide a better overall picture of nutrient intake b/c all food and beverages consumed in a specified period, usually 3 to 7 days are recorded.

dietary guidelines for Americans

science-based strategies complied by the public health service of the department of health and human services and the us department of agriculture. these guidelines provide advice to promote health and to reduce risk for major chronic diseases through diet and physical activity. update guidelines every 5 years.

Nutrients

some nutrients are considered essential because either they are not synthesized in the body or made in insufficient amounts. Essential nutrients that supply energy and build tissue (carbohydrates, fats, protein) are referred to as macronutrients. Non-essential nutrients do not have to be supplied through dietary sources because they either are not required for body functioning or are synthesized in the body in adequate amounts.

Nutrients

specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury.

economic factors

the adequacy of a person's food budget affects dietary choices and patterns. the increasing cost of food, coupled with limited purchasing power, may result in a decrease in the nutritional quality of the diet.

state of health

the alteration in nutrient requirements that results from illness and trauma varies with the intensity and duration of the stress. fevers increase the need for calories and water. chronic disorders for ex. , diabetes mellitus, renal disease, hypertension, heart disease, and cancers- can alter nutrient requirements by influencing nutrient intake, digestion, absorption, metabolism, utilization, or excretion.

Energy Balance

the body needs energy to function. energy is obtained from foods consumed. energy is measured in calories. only carbohydrates, protein, and fats provide energy. vitamins and minerals, needed for the metabolism of energy, do not provide calories. Energy in the body is used to carry on any kind of activity.

24-hour recall

the easiest way to collect dietary data is to obtain a 24-hour recall of all food and beverages the patient normally consumes during an average day. this method includes portion sizes, meal and snack patterns, meal timing, and location where food is eaten.

Basal Metabolism

the energy required to carry on the involuntary activities of the body at rest-the energy needed to sustain the metabolic activities of cells and tissues. these activities include actions such as maintaining body temp. and muscle tone, producing and releasing secretions, propelling food through the GI tract, inflating the lungs, and contracting the heart muscle.

outcome identification and planning

the goal is to maintain or restore optimal nutritional status using foods the patient like and tolerate as appropriate for their situation.

Protein functions

the major function of protein is to maintain body tissue that break down from normal wear and tear and to support the growth of new tissue. the nitrogen remaining after protein is metabolized burdens the kidneys. in addition, energy must be used to excrete nitrogen. like carbohydrates, protein consumed in excess of need can be converted to and stored as fat. protein intake should contribute 10% to 35% of total caloric intake for adults.

anthropometric data

used to determine body dimensions. in children, anthropometric measurements are used to assess growth rate; in adults, they can give indirect measurement of body protein and fat stores. Height and weight are the most common anthropometric measurements. weigh a pt. on the same scale each time and at the same time of day, preferably before breakfast.

factors to assess

usual dietary intake, food allergies or intolerances, food preparation and storage, type of dietary practices, and eating disorder patterns.

water

water accounts for btwn 50% to 60% of the adult's total weight. about 2/3 of the body's water is contained within the cells (intracellular fluid -ICF); the remainder is called extracellular fluid (ECF), which includes all other body fluids, such as plasma and interstitial fluid. total body water and ECF decrease with age; ICF increases with an increase in body mass. water is more vital to life than food. water aids in digestion, absorption, circulation, and excretion. as a lubricant, water is needed both for mucous secretions and for movement btwn joints. water intake (an average of 2,200 to 3,000 mL/day) usually equals water output.