Download Maintaining Nutritional Balance For Certified Nursing Assistants

Maintaining Nutritional Balance
For Certified Nursing Assistants
Maintaining Nutritional Balance
For Certified Nursing Assistants
2 In-service hours
Course Objectives:
1. List essential nutrients and recognize
dietary guidelines
2. Define nutrition
3. Learn the for “P’s” of nutrition
4. Understand the food label
5. List steps to proper nutrition
Introduction:
Good nutrition is essential to good health. A balanced diet and exercise play
a leading role in maintaining health and well being. Following the
recommended guidelines and the use of the food pyramid will also be
essential in planning for a well balanced day of essential vitamins, nutrients,
minerals, and proper caloric intake.
Overview of Digestion
Eating occurs in the digestive system beginning in the mouth with chewing
and cutting food into portions to swallow, and passing from there to the
esophagus to the stomach.
Digestion occurs in the stomach and small intestines with help from the
liver, pancreas, and the gall bladder.
Absorption of food occurs in the small intestines. Absorption of fluid occurs
in the large intestines.
Usage occurs as nutrients are consumed by cells of the body.
Storage occurs in muscle and fat tissue.
Six Essential Nutrients
The six essential nutrients are water, protein, carbohydrates, fats, vitamins
and minerals.
Almost any food you eat is composed of dozens or even hundreds of
different kinds of materials, tinier by far than the smallest things that can be
seen with the most powerful microscope, such as atoms and molecules.
Water makes up about 60% of the body’s weight. It helps regulate the body’s
temperature and protects organs from injury. Water is lost through vomiting,
urine, feces, perspiration and respiration. A human body should have at least
one to one and a half quarts of water per day.
Protein is necessary for growth, the healing and repair of body tissues, and
fighting off diseases. Everybody cell is made up of protein. One gram of
protein gives the body four calories of energy.
Carbohydrates are necessary for body energy, and most offer fiber to help
with bowel elimination. Carbohydrates are broken down into sugars during
digestion and absorbed into the blood. Excess is stored in the liver and body
fat. One gram of carbohydrates gives the body four calories of energy.
Fats are also sources of body energy. Fats assist in the body’s use of vitamins
and in conserving body heat. Fats also protect the body ‘s organs from injury.
One gram of fat gives the body nine calories of energy.
Definition of Nutrition
Nutrition includes the process of eating, digesting, absorbing, using, and
storing food and fluids for body growth, healing, and body functions. The
definition of nutrition is the process of providing or obtaining the food
necessary for health and growth. Nutrition is the study of nutrients in food
and the body’s usage and handling of these nutrients. Nutrition is the study
of nutrients and their digestion, absorption, transport, metabolism,
interaction, storage and excretion. A broader definition includes the study of
the environment and of human behavior as it relates to nutrition
Function Of Vitamins
Vitamins each have a specific role in the body’s ability to function.
Vitamin A
Growth, Vision, Hair
Vitamin B (s)
Muscle tone, nerve functions, digestion, growth,
metabolism, and formation of RBC’s
Vitamin C
Healing, resistance to infection, and healthy blood
vessels
Vitamin D
Stronger, health bones
Vitamin E
Muscle function, formation of RBC’s
Vitamin K
Blood Clotting
Other Essential Nutrients
Minerals
Each have a specific role in normal body function as below:
Calcium
Teeth and bones, blood clotting, nerves, heart, and muscles
Phosphorus
Teeth and bones, use of proteins, fats and carbohydrates,
nerve and muscle functions
Iron
Red Blood Cells to carry oxygen
Iodine
Thyroid function
Sodium
Fluid balance, nerve and muscle functions
Potassium
Nerve and Heart function and muscle contraction
Dietary Guidelines
The US Department of agriculture and the US Department of Health and
Human Services have published seven basic dietary guidelines.
They are as follows:
1.
Eat a variety of foods
2.
Maintain a healthy weight
3.
Choose a diet low in fat, saturated fats and cholesterol
4.
Choose a diet with plenty of vegetables, fruits and grain products
5.
Use sugars only in moderation
6.
If you drink, do so in moderation
7.
Use salt and sodium in moderation
Lets look at each of these recommendations.
Eat a variety of foods:
You need more than 40 different nutrients for good health. Essential
nutrients include vitamins, amino acids from protein, certain fatty acids from
fat, and sources of calories (protein, carbohydrates, and fat) these nutrients
should come from a variety of foods, not from a few highly fortified foods or
supplements. Any food that supplies calories and nutrients can be a part of a
nutritious diet. The content of the diet over the course of a whole day or
more is what counts.
Many foods are a good source of several nutrients. Vegetables and fruits are
an important source for Vitamin A and Vitamin C, folic acid, minerals and
fiber.
Breads and cereals supply Vitamin B, iron, and protein. Whole grain types
are a good source of fiber.
Milk provides protein, Vitamin B, Vitamin A and D, calcium and
phosphorus. Meat, poultry and fish are a good source for protein, Vitamin B,
iron and zinc.
No single food can supply all nutrients in all the amounts that are needed.
For example, milk supplies calcium, but not very much iron. Meat products
supply iron, but not much calcium. To have a balanced diet, you have to eat
a variety of foods.
Maintaining a healthy weight
If you are too overweight, or too thin, your chances of developing health
problems are significantly increased. Being overweight is common in the
United States. It is linked with high blood pressure, heart disease, stroke,
diabetes, cancers, and several other illnesses.
Being too thin is a less common problem. It typically occurs with anorexia
nervosa and is linked to osteoporosis in women. Being too thin also
increases the risk for early death in many people.
The dietary guidelines suggest eating in moderation. Avoid extremes in diet.
Both eating too much and eating too little can be harmful. Be cautious of
diets based on belief that a food or supplement alone can cure or prevent
diseases.
SUGGESTED HEIGHT AND WEIGHT TABLE FOR ADULTS
Reprinted with permission from Doctor’s pocket fat calorie counter
Height
19-34 yrs
35 yrs and over
5’0
98-128
108-138
5’1
101-132
111-143
5’2
104-137
115-148
5’3
107-141
119-152
5’4
111-146
122-157
5’5
114-150
126-158
5’6
118-155
130-160
5’7
121-160
134-170
5’8
128-164
138-178
5’9
129-169
142-180
6’0
132-174
146-185
6’1
136-179
151-194
6’2
140-182
155-197
6’3
152-200
159-200
6’4
156-204
164-210
6’5
160-211
168-215
6’6
164-216
173-220
6’7
168-225
177-228
6’8
172-205
182-230
Table heights are without shoes and without clothes
The higher weights generally apply to men, who generally have more
muscle mass and bone than women.
Choose a diet low in fat
Choose a diet low in fat, cholesterol, and saturated fats. Most health
guidelines suggest a diet with less fat, and less cholesterol than the typical
American diet, generally contains.
A diet low in fat makes it easier for you to include a variety of foods you
need for nutrients without exceeding caloric needs. Fat contains over twice
the calories of an equal amount of carbohydrates or protein.
A diet low in saturated fat and cholesterol can help maintain a desirable level
of blood cholesterol. For adults a healthy level is generally below 200mg/dl.
As blood cholesterol increases, greater health risks become a big concern.
There becomes a greater risk for heart disease. Risk can also be increased by
high blood pressure, and cigarette smoking. Other factors include diabetes, a
family history of heart disease, obesity and being male.
Choose a diet with plenty of vegetables, fruits and grain products
This guideline recommends that adults eat at least three servings of
vegetables and two servings of fruits daily. It is recommended that at least
six servings of grain products, such as breads, pasta and rice with an
emphasis on whole grains. Children should be encouraged to also eat plenty
of these foods. Vegetables, fruits and grain products are important parts of
the various diets recommended by the US Department of Agriculture and the
US Department of Health and Human Services.
These foods are typically a good source of complex carbohydrates, dietary
fiber, and components for good health. These foods are low in fat. By
choosing the suggested amounts, you are likely to increase carbohydrates
and decrease fat in your diet. This will also contribute to more fiber.
Three or more servings of vegetables are recommended. There should be a
variety of dark green, leafy and deep yellow vegetables often.
The body also needs starches such as in potatoes and corn.
Two or more servings of fruits are recommended. Choose fruits as desserts
and fruit juices as beverages.
It is recommended that the body have six or more servings of grain products
each day. Eat products from a variety of grains such as wheat, rice, oats, and
corn.
Vegetables, fruits, and grain products are generally low in calories if fats and
sugars are used sparingly in the preparation and at the table.
Sugar in moderation
Americans eat sugar in many forms. Sugars provide calories and many like
the taste of sweet things. Some serve as natural preservatives, thickeners,
and baking aids in many foods. This guideline cautions against eating sugar
in large amounts and cautions against frequent snacking of foods containing
sugar and starches.
Sugars and many foods that contain sugar in large amounts supplies calories
but are limited in nutrients. They should be used in moderation by most
healthy people with low calorie needs; sugars can be an additional source of
calories.
Salt in moderation
Table salt contains sodium and chloride. Both are essential in the diet.
However, most Americans eat more salt and sodium than is needed. Keep in
mind that many food and beverages contain sodium, accounting for the
major amount of sodium that is taken in each day. (Much of the sodium is
added during manufacturing and processing) Therefore, there is really no
need to supplement food with table salt, other than to get the benefit of
flavor. We certainly do not need added salt for dietary guidelines to get the
proper amount of sodium each day.
In populations that eat diets low in salt, have a much lower incidence of high
blood pressure. Other factors that contribute to high blood pressure include
hereditary factors, obesity, and excessive drinking of alcoholic beverages.
In America about 1 in 3 people suffer from high blood pressure. Many of the
times, blood pressure can improve by eliminating salt and sodium in the diet.
Alcohol consumption
Alcoholic beverages supply calories but have no nutritional value. If adults
consume alcohol, it should be done in moderation. Moderation is defined as
no more than one drink a day for a woman, and no more than two drinks a
day for a male.
One beer = one drink
5 ounces wine = one drink
1 ounce of liquor (80 proof) = one drink
Food pyramid
The Food Guide Pyramid has a goal to help people plan healthy eating
patterns based on Dietary Guidelines for Americans.
It provides:
1.
Ample amounts of essential nutrients
2.
Moderate consumption of fat, saturated fats, cholesterol, and added
sugars.
Food groups that make up the largest group or the base of the pyramid are
made up of plant foods. These are the foods that should make up the largest
portion of a healthy diet. They include bread, cereal, rice, grains, vegetables
and fruits.
They are an excellent source of fiber, low fat, vitamins and minerals.
The pyramid’s shape also suggests that a moderate amount of lower fat/lean
meat be included in a healthy diet. Look for foods from the milk and meat
groups to compliment foods from the grains, fruits and vegetable groups.
Fats, oils, and sweets are at the point of the pyramid, suggesting using only
moderately.
Factors affecting good nutrition
1.
Physical health is the most important factor affecting adequate and
proper nutrition. A person’s ability to ingest, digest, and transport food
is affected by poor absorption, metabolism, and diseases. Medications
can interfere with the proper absorption and utilization of nutrients.
2.
Emotional health can have a big impact on nutritional status. Trauma
and disease cause periods of increased stress and depression, which in
turn may require an increase in calorie consumption, or can contribute
to en excessive amount of calories ingested. Small amounts of foods
more frequently are suggested.
3.
Age, ethnic background, culture, activity level, social background and
family social factors play an important role in nutrition.
4.
Sometimes the elderly have problems related to poorly fitting dentures,
gum problems, and poor appetites.
5.
Activity level also affects a person’s nutritional status. Decreased
physical activity can reduce energy demands.
6.
Social background affects nutrition in the aspect that if an individual
dines out frequently, there is a significant contribution to fat and
calories in the diet.
7.
Cost is always a factor influencing good nutrition. Foods high in protein
are usually the most expensive to purchase.
Four P’s Of Nutrition
1.
Planning
2.
Purchasing
3.
Preparing
4.
Presenting
Planning- A plan is essential to considering special likes and dislikes of a
client as well as special diets ordered by the physician.
Purchasing- When the plan is created, the next step is to purchase foods with
good nutritional value.
Preparing- Foods should be cooked to avoid unnecessary fat contact.
Streamed, baked or broiled will have more benefit than foods that are fried.
Presenting- How the food looks is very important to tempting the patient and
or anyone to eat well, A variety is important as well as small portions. Small
portions are not as overwhelming to patients, and are generally a good way
to increase over all consumption each day.
FOOD LABELS/ WHAT DO THEY ALL MEAN?
Fat Free- less than 0.5 grams of fat per serving’
Low Fat- 3 grams of fat or less per serving
Lean- less than 10 grams of fat
Light- one-third less calories, one-half less fat, one-half less sodium
Cholesterol Free, Less than 2 milligrams of cholesterol and 2 grams or less
of saturated fat per serving.
A serving size is according to the recommendation on the label; if you eat
double the portions you must double the calories and the nutritional
information on the label.
Keep in mind that the ingredient that the product contains the most of is
listed first, and in descending order of the contents on the ingredients label.
Role of Vitamins
Much of what we take for granted can be contributed to the proper intake of
vitamins. For example, eye sight, healthy bones, muscle tone, breathing
ability ect, all a result of the fat soluble vitamins A, D, E, and K.
Fat Soluble vitamins are absorbed by the lymph system with fat, carried by
proteins and excess is stored.
Water soluble vitamins are absorbed in the blood, and excreted in urine.
Vitamin A has the distinction of being the first fat soluble vitamin to be
recognized.
Water soluble vitamins include the B complexes and Vitamin C.
Table of B Vitamins
Correct name
and other common name
Thiamin
Vitamin B 1
Riboflavin
Vitamin B 2
Niacin
Nicotinic acid, nicotinamide
Vitamin B6
pyridoxine
Pantothenic acid
None
Folacin
Folic Acid, Folate
Vitamin B 12
cobalamin
Biotin
None
References:
Understanding Clinical Nutrition
Whitney-Cataldo
West Publishing 1983
Doctor’s pocket guide to fat and carbohydrates
Allan Borushek, 2002
United States Health and Human Services
www.ushhs.org
American Association of Dietetics Association