Download Chapter 3

Chapter 35
Nutrition
Physiology of Nutrition
 Nutrition is the process by which the
body metabolizes and utilizes the
nutrients from food.
 Nutrients are digested, absorbed by the
blood or lymphatic system, and
transported to the body’s cells.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-2
Physiology of Nutrition
 Digestion is the process by which
ingested foods are broken down in the GI
tract to smaller segments in preparation
for absorption.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-3
Physiology of Nutrition
 Absorption is the process by which the
end products of digestion pass through
the epithelial membranes in the small
and large intestines into the blood or
lymph systems.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-4
Physiology of Nutrition
 The end products of digestion are
monosaccharides (simple sugars), amino
acids, glycerol, fatty acid chains,
vitamins, minerals, and water.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-5
Physiology of Nutrition
 Metabolism is the aggregate of all
chemical reactions and process in every
body cell, such as growth, generation of
energy, elimination of wastes, and other
bodily functions as they relate to the
distribution of nutrients in the blood after
digestion.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-6
Physiology of Nutrition
 Metabolic rate refers to the rate of heat
liberation during chemical reactions.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-7
Metabolism
 Energy
• A calorie is the unit of measurement used to
express the quantity of energy released
during metabolism.
• Energy is expressed in terms of kilocalories.
• Basal metabolic rate (BMR) represents the
energy needed to maintain essential
physiological functions.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-8
Metabolism
 Excretion
• Digestive and metabolic waste products are
excreted through the intestines and rectum.
• Other excretory organs are the kidneys,
sweat glands, skin, and lungs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-9
Nutrients






Water
Vitamins
Minerals
Carbohydrates
Proteins
Lipids
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-10
Nutrients
 Water
• Accounts for 60% to 70% of an adult’s total
body weight and 77% of an infant’s weight.
• Water and electrolytes are substances that
must be acquired from the diet.
• Body water requirements are met through
consumption of liquids and foods and the
oxidation of food.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-11
Nutrients
 Vitamins
• Organic compounds that aid in the
regulation of cellular metabolism and assist
in the biochemical processes that release
energy from digest food
• Vitamins are classified as fat-soluble or
water-soluble.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-12
Nutrients
 Minerals
• Serve as catalysts in biochemical reactions.
• Classified according to daily requirement:
- Macrominerals (quantities of 100mg or greater)
- Microminerals (trace elements, quantities less
than 100 mg)
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-13
Nutrients
 Carbohydrates
• Organic compounds composed of carbon,
hydrogen, and oxygen
• Primary source of energy for the brain and
the preferred fuel for the body
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-14
Nutrients
 Carbohydrates
• Monosaccharides (simple sugars) include
glucose, galactose, and fructose.
• Disaccharides (double sugars) include
sucrose, lactose, and maltose.
• Polysaccharides (complex sugars) include
glycogen, cellulose (fiber), and starch.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-15
Nutrients
 Proteins
• Organic compounds that contain carbon,
hydrogen, oxygen, and nitrogen atoms
• Essential for almost every bodily function
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-16
Nutrients
 The end products of protein digestion are
amino acids.
 Nonessential amino acids can be
synthesized in the cells.
 Essential amino acids must be ingested
in the diet because they cannot be
synthesized in the body.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-17
Nutrients
 Proteins are also classified as complete
or incomplete.
• High-biological-value proteins (complete
proteins) contain all the essential amino
acids.
• Low-biological-value proteins (incomplete
proteins) lack one or more essential amino
acid.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-18
Nutrients
 Protein Deamination is the process of
removal of (degradation) amino groups
from the amino acids.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-19
Nutrients
 Other physiological processes occur
during protein deamination.
• Gluconeogenesis
• Ketogenesis
• Nitrogen balance
• Positive nitrogen balance
• Negative nitrogen balance
• Obligatory loss of proteins
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-20
Nutrients
 Lipids (fats)
• Organic compounds are the only essential
nutrients that cannot mix with water and
therefore, must be emulsified by molecules
to be absorbed.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-21
Nutrients
 Fatty Acids
• Simplest form of lipids and the basic components of
more complex lipids
• Saturated fatty acids form fats, which are glycerol
esters of organic acids whose carbon atoms are
joined by single bonds.
• Unsaturated fatty acids form glycerol esters of
organic acids whose carbon atoms are joined by
double or triple bonds.
 Monounsaturated Fatty Acids
 Polyunsaturated Fatty Acids
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-22
Nutrients
 Fatty Acids
• Monounsaturated fatty acids are formed
esters with one double or triple bond.
• Polyunsaturated fatty acids form esters that
have many carbons unbonded to hydrogen
atoms.
• Hydrogenated or trans-fatty acids are
another category of fat that is not naturally
occurring but man made.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-23
Nutrients
 Most Important Lipids
• Triglycerides are composed of three fatty
acid cells attached to a glycerol molecule.
• Phospholipids are composed of one or more
fatty acid molecules and one phosphoric
acid radical; they usually contain a
nitrogenous base.
• Cholesterol is produced by the body and is
considered a fat; it is also found in whole
milk and egg yolk.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-24
Promoting Proper Nutrition
 Recommended Daily Allowances (RDAs)
 The Food Guide Pyramid outlines six
groups of food and the number of
servings based on dietary guidelines and
the basic four food groups.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-25
Promoting Proper Nutrition
 Societal Concerns
• One-third of the U.S. population is
considered overweight.
• Obesity is becoming an epidemic.
• Undernutrition is a specific problem for the
elderly and for people with eating disorders.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-26
Weight Management
 Overweight is an energy imbalance in
which more food is consumed than
needed.
 An underweight person expends more
calories than are consumed.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-27
Weight Management
 Anorexia nervosa (self-starvation)
disrupts metabolism because of
inadequate calorie intake.
 Bulimia nervosa refers to food-gorging
binges followed by purging of food,
usually through self-induced vomiting or
laxative abuse.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-28
Factors Affecting Nutrition
 Age
 Lifestyle
 Ethnicity, Culture, and Religious
Practices
 Economics
 Gender
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-29
Assessment
 Nutritional History
•
•
•
•
24-hour recall
Food-frequency questionnaire
Food record
Diet history
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-30
Assessment
 Physical Examination
• Intake and Output (I & O)
• Anthropometric Measurements
- Skinfold measurements
- Mid-upper-arm circumference
- Abdominal-girth measurement
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-31
Assessment
 Measuring the midupper-arm
circumference
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-32
Diagnostic and Laboratory Data




Protein Indices
Serum Albumin
Pre-albumin
Serum Transferrin
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-33
Diagnostic and Laboratory Data




Hemoglobin Level
Total Lymphocyte Count
Nitrogen Balance
Urine Creatinine Excretion
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-34
Nursing Diagnoses
 Imbalanced Nutrition: Less Than Body
Requirements
 Imbalanced Nutrition: More Than Body
Requirements or Risk for More Than
Body Requirements
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-35
Other Nursing Diagnoses






Activity Intolerance
Acute Pain
Ineffective Health Maintenance
High Risk for Impaired Skin Integrity
Constipation
Impaired Swallowing
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-36
Outcome Identification and
Planning
 Expected outcomes are formulated to
promote optimal nutritional care.
 In the planning phase, the nurse
identifies dietary needs and explains the
need for and basis of therapy.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-37
Implementation
 Monitoring Weight and Intake
 Diet Therapy
•
•
•
•
•
•
Nothing by Mouth (NPO)
Clear-Liquid
Liquid
Soft
Mechanical Soft
Pureed
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-38
Implementation
 Diet Therapy
•
•
•
•
•
•
Low-residue
High-fiber
Liberal bland
Fat-controlled
Sodium-restricted
Lactose intolerance
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-39
Implementation
 Assistance with Feeding
 Providing Nutrition Support
 Nutrition Support Teams
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-40
Implementation
 Providing Enteral Nutrition
• Feeding tubes
• Insertion of enteral feeding tubes
• Enteral formulas
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-41
Enteral Feeding Routes
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-42
Implementation
 Administration of Enteral Feedings
• Safety considerations
• Potential complications
• Removal of a nasogastric tube
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-43
Implementation
 Providing Parenteral Nutrition (PN)
• Intravenous infusion of a solution directly
into a vein to meet the client’s daily
nutritional requirements
• Used to treat malnourished clients or clients
who have the potential for becoming
malnourished and who are not candidates
for enteral support.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-44
Implementation
 Components of Parenteral Nutrition
• Carbohydrates found primarily in form of
dextrose
• Amino acids
• Lipids (fat emulsions)
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-45
Implementation
 Administering Medication through a
Feeding Tube
•
•
•
•
•
•
Types of feeding tubes
Checking for tube placement
Clearing the tubing of formula
Checking the patency of tube
Flushing the port
Measuring intake and output
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-46
Implementation
 Complementary Therapy
• Nutrition is integrated as part of the
therapeutic regimen of numerous types of
complementary therapies.
• Diet and nutrition are used by many
alternative modalities for the prevention and
treatment of chronic diseases.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-47
Evaluation
 Current data is used to measure
achievement of goals and outcomes.
 The plan of care is modified to maximize
the client’s response to therapy.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
35-48