Download Chapter 26

Chapter 26
Concepts of
Basic Nutrition and Cultural
Considerations
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Chapter 26
Lesson 26.1
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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
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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
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Overview of the
Gastrointestinal System
Structures involved in the
digestive system
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Mouth
Teeth
Tongue
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Anus
Accessory organs
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Salivary gland
Liver
Gallbladder
Pancreas
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Figure 26-1: The
gastrointestinal system
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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
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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
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Largest salivary glands
One on each side
Located anterior and inferior to the ear
Secrete saliva into the mouth
Begins digestion of starches
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Chapter 26
Lesson 26.2
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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
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Carbohydrates
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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
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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
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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
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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
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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
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Fats
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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
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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
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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
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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
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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
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Figure 26-4: Food label
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Water
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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
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Chapter 26
Lesson 26.3
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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