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Chapter 26 Concepts of Basic Nutrition and Cultural Considerations Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 1 Chapter 26 Lesson 26.1 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 2 Learning Objectives Theory • Review the structure and function of the gastrointestinal system • Utilize the components of the USDA MyPyramid website to assist patients to plan their diets • Discuss the function of proteins, carbohydrates, fats, vitamins, minerals, and water in the human body Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 3 Learning Objectives Theory • Identify food sources of proteins, carbohydrates, fats, vitamins, and minerals • List medical conditions that may occur as a result of protein, calorie, vitamin, or mineral deficiency or excess Clinical Practice • Identify patients at risk for nutritional deficits Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 4 Overview of the Gastrointestinal System Structures involved in the digestive system • • • • • • • • • Mouth Teeth Tongue Pharynx Esophagus Stomach Small intestine Large intestine Anus Accessory organs • • • • Salivary gland Liver Gallbladder Pancreas Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 5 Figure 26-1: The gastrointestinal system Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 6 Functions of the Organs of Digestion Mouth • First part of the digestive tract • Contains tongue and teeth and receives secretions from the salivary glands – Tongue composed of mostly skeletal muscle; the most movable organ of the mouth – Adults have 32 permanent teeth • Cuspids, incisors, bicuspids, and molars Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 7 Functions of the Organs of Digestion Mouth • Receives food and breaks it down into smaller pieces; mixes food with saliva and starts the digestive process Parotid glands • • • • • Largest salivary glands One on each side Located anterior and inferior to the ear Secrete saliva into the mouth Begins digestion of starches Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 8 Functions of the Organs of Digestion Pharynx • Connects the nasal and oral cavities to the esophagus; food is forced into the pharynx by the tongue Esophagus • Muscular tube approximately 20 cm long • Propels food into the stomach from the pharynx using muscular contraction • Lining secretes mucus Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 9 Functions of the Organs of Digestion Stomach – Located in the upper left quadrant of the abdomen; has a capacity of approximately 1.5 L – Has two sphincters – Is a temporary storage place for food – Mixes food with digestive juices – Changes food into a semiliquid state – Begins the digestion of proteins – Absorbs vitamin B12 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 10 Functions of the Organs of Digestion • Small intestine (duodenum, jejunum, ileum): mixes food with secretions from liver and pancreas; finishes digestion; absorbs nutrients • Large intestine (ascending, transverse, descending, and sigmoid colon; rectum; anus; cecum): absorbs fluid and electrolytes; eliminates waste products • Liver and gallbladder: concentrate, store, and secrete bile into the duodenum • Pancreas: secretes digestive juices; produces insulin Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 11 Effects of Aging on GI Tract • Dental caries and tooth loss – Decrease a person’s ability to chew food • Decreased gag reflex – Increases the risk of aspiration • Decreased sense of taste – May lead to loss of appetite Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 12 Effects of Aging on GI Tract • Decreased muscle tone at sphincters – Increases risk of esophageal reflux • Decreased gastric secretions – May interfere with digestion of food • Decreased peristalsis – Increased risk of constipation Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 13 Metabolism • Process in which large molecules are broken down into smaller molecules • Makes energy available to the organism • Enables absorbed nutrients to enter bloodstream following digestion – Digestion converts food into chemical substances such as proteins and simple sugars to be used by the body for energy production and cellular metabolism Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 14 Dietary Guidelines • USDA MyPyramid – Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products – Includes lean meats, poultry, fish, beans, eggs, and nuts – Is low in saturated fats, trans fats, cholesterol, sodium, and added sugars Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 15 Protein • Constant supply essential for rebuilding and replacing body tissues • Plays a role in hormone production, fluid balance, antibody production, and transportation of nutrients • Supplies approximately 4 calories/g • Composed of amino acids – 9 essential – 11 nonessential Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 16 Food Sources: Protein • Animal sources – Red meat, eggs, milk and milk products, poultry, fish – Complete, or high-quality proteins • Plant sources – Grains, legumes, and most vegetables – Incomplete, or low-quality proteins Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 17 Food Sources: Protein • Average DRI is 46 to 56 g of protein per day for the healthy adult • Protein intake should be 10% to 15% of the total daily calories • May vary depending on activity level, state of health, and availability of protein food sources Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 18 Proteins Protein deficiency • Marasmus – A form of protein energy and nutrient malnutrition – Occurring chiefly in the first year of life, characterized by growth retardation and wasting of subcutaneous fat and muscle • Kwashiorkor – A condition occurring in infants and young children soon after weaning from breast milk Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 19 Proteins Protein excess • Stressful to the liver and kidneys – Kidneys must rid the body of excess waste products – Liver function is strained with the excess load of protein to metabolize • Can lead to excess fat in the diet Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 20 Vegetarian Diets • Lacto-ovo-vegetarian – Dairy products, eggs, and plant foods included in the diet • Lactovegetarian – Eggs are excluded; dairy products and plant foods included • Vegan – All animal food sources are excluded, including honey Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 21 Vegetarian Diets • Well-planned vegetarian diets offer health benefits – Decreased risk of heart disease, hypertension, diabetes, and obesity • Vegans may have a diet deficient in – Vitamin B6, vitamin B12, iron, zinc, riboflavin, and vitamin D Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 22 Chapter 26 Lesson 26.2 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 23 Learning Objectives Theory • Discuss the function of proteins, carbohydrates, fats, vitamins, minerals, and water in the human body • Identify food sources of proteins, carbohydrates, fats, vitamins, and minerals • List medical conditions that may occur as a result of protein, calorie, vitamin, or mineral deficiency or excess Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 24 Carbohydrates • • • • The body’s main source of energy Should make up 50% to 60% of the daily diet Supply 4 calories/g Regulate protein and fat metabolism, fight infection, and promote growth of body tissues • Three main types: – Simple, complex, and fiber Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 25 Carbohydrates • Simple carbohydrates – Glucose is the metabolized form of sugar found in the body and is found in: • Table sugar (sucrose), the major sweetener found in foods • Fruit sugar (fructose) • Milk sugar (lactose) • Quickly absorbed into the bloodstream • Cause a quick rise in serum glucose Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 26 Carbohydrates • Complex carbohydrates – Breads, pasta, cereals, and rice – Broken down into simple sugars for use by the body – Provide a more consistent serum glucose level than simple sugars provide – Recommended that 85% to 95% of consumed carbohydrates are complex carbohydrates Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 27 Carbohydrates • Fiber – The portion of the carbohydrate that cannot be broken down during digestion – Passes through the intestine undigested – Increases bulk in the stool – Aids in elimination – May decrease absorption of fat – Recommended intake 21 to 38 g/day Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 28 Food Sources: Fiber • Fruits – Apples, bananas, oranges, grapefruits – Cantaloupe, strawberries • Vegetables – Green beans, broccoli, cauliflower, celery – Corn, potato (with skin), sweet potato • Grains and cereals – Breads, all bran, oatmeal, shredded wheat • Legumes (cooked) – Beans: kidney, pinto, lima; black-eyed peas Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 29 Fats • • • • • • • • • • • An essential nutrient Supplies a concentrated form of energy Supplies 9 calories/g consumed Provides source of fatty acids Adds flavor to foods and contributes to texture Dissolves and transports fat-soluble vitamins and fat-soluble phytonutrients (carotenoids) Insulates and controls body temperature Makes food smell appetizing Cushions and protects body organs Facilitates transmission of nerve impulses Gives feeling of fullness after eating Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 30 Fats • Made up of fatty acids and glycerol • Fatty acids are classified as saturated or unsaturated • Fatty liquids at room temperature are called oils • Oils containing unsaturated fats: – Corn oil, safflower oil, canola oil Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 31 Fats Omega-3 fatty acids • The most unsaturated form of fatty acid • Found in salmon, halibut, sardines, tuna, canola oil, soybean oil, chicken, eggs, and walnuts • Should be added to the diet as sources of unsaturated fats Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 32 Vitamins • Essential nutrients that must be taken in through food sources or supplements • Water-soluble vitamins – Easily absorbed into the bloodstream for use by the body – B-complex vitamins and vitamin C • Fat-soluble vitamins – Absorbed in the small intestine the same as other fats by action of bile in the duodenum and stored in the liver – A, D, E, and K Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 33 Minerals • Inorganic substances found in animals and plants • Essential for metabolism and cellular function • Major minerals – Calcium, magnesium, sodium, potassium, phosphorus, sulfur, chlorine • Trace minerals – Iron, copper, iodine, manganese, cobalt, zinc, molybdenum, selenium, fluoride, chromium Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 34 Figure 26-4: Food label Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 35 Water • • • • Water is the most essential of all nutrients Adult body is 50% to 69% water Water requirement is 1 mL/calorie of intake Used in every body process, from digestion to absorption to elimination or secretion; large amount must be stored in the body • General rule: intake needs to be equal to recorded output plus 500 mL Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 36 Chapter 26 Lesson 26.3 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 37 Learning Objectives Theory • Identify a variety of factors that influence nutrition • Describe cultural influences on nutrition practices • Identify nutritional needs throughout the life span • Discuss components of a basic nutritional assessment Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 38 Learning Objectives Clinical Practice • Identify patients at risk for nutritional deficits • Complete a nutritional assessment on an assigned patient • Use therapeutic communication with a patient while discussing needed diet modification • Develop a teaching plan for the patient for whom a therapeutic diet is prescribed Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 39 Factors Influencing Nutrition • Age: infants, toddlers, preschool, school-age, adolescents, adults, older adults • Illness • Emotional status • Economic status • Religion: Islam, Judaism, Seventh-Day Adventist • Culture: African American, Hispanic, Asian • Assessment, Nursing Diagnosis, Planning • Implementation, Teaching • Evaluation Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 40 Nutritional Needs Through the Life Span: Infants – Should double birth weight by 6 months and triple weight by 1 year – Breast milk recommended • AAP recommends breast milk for first full year – Formulas • Modified form of cow’s milk, made more digestible with added carbohydrate and fat content – Solids introduced in diet at 4 to 6 months Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 41 Nutritional Needs Through the Life Span: Toddlers and Preschool • Ages 2 to 5 years • Consume less milk and increase intake of solids • Provide small servings • Offer foods that are easy to chew • Avoid combination foods – Toddlers prefer single-item foods that do not touch each other on the plate • Try colorful foods (e.g., peas, carrots) Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 42 Nutritional Needs Through the Life Span: Toddlers and Preschool • Provide a pleasant environment at mealtimes • Provide plates and utensils in a size that can be easily handled by the small child • Use dishes that are colorful and/or contain pictures of favorite characters • Avoid forcing a child to eat Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 43 Nutritional Needs Through the Life Span: School-Age Children • May desire sweet, non-nutritive foods such as soda, candy, cake, and ice cream • Provide well-balanced breakfast before school • Provide nutritious after-school snacks • High-calorie, high-sodium preferences may predispose to obesity Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 44 Nutritional Needs Through the Life Span: Adolescents • Tend to consume many fast foods, either from restaurants or vending machines • During growth spurt the body requires more calories as well as nutrients • Adolescent females require increased levels of iron after the menstrual cycle begins Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 45 Nutritional Needs Through the Life Span: Adulthood • Rely on fast foods and convenience foods • Obesity and hypertension prevalent • Have increased fat and sodium intake • Have increased sugar intake • Lack exercise Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 46 Nutritional Needs Through the Life Span: Older Adults • Most at risk for inadequate nutrition • May need to decrease calories if activity level is decreased • Physical limitations make food preparation more difficult • Arrange for companionship during meals • Some older adults have limited incomes and must limit food choices Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 47