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Nutrition
Nutrition – You Are What You Eat
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Nutrition – Has been defined as the food
you eat and how your body uses it.
Nutrients – are chemical substances
supplied by food that the body needs for
growth , maintenance and repair
Macronutrients – are carbohydrates, fats,
and proteins
CHO, fats are well known as fuel foods –
but protein is sometimes forgotten
CHO – 4Kcal/gm
FAT – 0 Kcal/gm
Protein – 4 Kcal/gm
Diet & Illness
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Some of out nation’s
top leading causes of
death have been
associated with diet:
1. Coronary heart
disease
2. Certain types of
cancer
3. Stroke
4. Diabetes
5. Atherosclerosis
Nutrition - Purpose
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1. Provide
energy for body
processes &
movement
2. Provide
structural
material for
body tissue
3. Regulating
body processes
Photosynthesis
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Plants with green leaves trap the radiant
energy of sun & through this process,
store it as chemical energy in CHO
CO2 = H2O + Chlorophyll = CHO ---either as a starch or sugar
Plants – Such as:
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potatoes, wheat, rice = starch
peas, bananas, cherries, or beets = sugar
CHO (Carbohydrates) are most
economical form of energy, readily
accessible foods, the energy used by the
brain
Simple vs Complex Carbohydrates
Simple:
 Monosacchrides:
 Glucose,
Fructose,
Galoctose
 Foods: grapes,
oranges, dates,
honey, corn syrup
 Type CHO that is
absorbed from
intestinal tract
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Simple CHO
Disacchrides :
Double sugar
 Succose,
maltose,
lactose
 W & B Sugar,
molasses,
honey, sweet
potatoes,
pineapples,
carrots
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Complex CHO
Polysaccharides  Starches
 Fiber
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Complex - Polysaccharides
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Starches – Large
molecule of glucose
Requires longer to
digest
Glucose available
slower
Ex: Cereal grains,
corn, peas, potatoes,
squash, legumes
Starch increases with
maturity
Fiber
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Cellulose
Absorbs water to
provide bulk or
roughage in diet
Bulk stimulates
peristalsis
Cellulose is
undigested
Dietary Fiber 20-35 g/day
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Soluble:
Able to dissolve in
H2O
Beans, oatmeal,
barley, broccoli,
citrus fruits
Regulate blood
glucose level
Weight loss
Lowers cholesterol
Dietary Fiber
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Insoluble:
Incapable of being
dissolved
Fruits and veg.
skins, nuts, popcorn
Promote bowel
regularity
Decreases risk
diverticular
diseases, cancer
Circulating Blood Glucose
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40mg/dl - 80 -- 120 - 160 - 180 --- 500
Hypoglycemia
Body secretes
Hormones i.e.
Epinephrine,
Growth
*Glucagon
Glucose Exceeds
Renal threshold
Glucosuria
Insulin is secreted
from Beta cells of
Pancreas to< BGL
Circulating Blood Glucose (con’t)
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*Glucagon (Job is to
increase BGL)
Is secreted by alpha cells
of pancreas
Stimulates the breakdown
of glycogen & release of
glucose by the liver >
increases blood sugar
levels
That’s why if you are
hungry @ 10-11am you
will be able to wait until 1
pm or so to eat
Circulating Blood Glucose (con’t)
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Glycogen:
Is a polysaccharide
Is stored in liver & muscle tissue (called
animal starch)
Is a string of glucose.
50-75 gm of glucose is stored in the liver as
“hepatic glycogen”
An adult male has 300 gm stored in the liver &
muscles
An important link in energy metabolism:
Helps sustain normal blood sugar levels during
fasting periods such as sleep hours
Provides immediate fuel for muscle action
especially athletic activity.
Digestion of CHO
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Mouth -> chewing food particles ->mixes with
Saliva (Salivary Amylase) > changing dextrins &
maltose
Stomach – Mixing continues > Thicker > Chyme
Small Intestines – With aide of:
Pancreatic Amylase & Intestinal Secretions >
conversion from complex to simple sugars
From small intestines ->
1. portal circulation to liver to be converted to
glucose & then glycogen & Stored
2. To blood stream to all cells for Energy
3. Or stored as Fat
CHO: Signs & Symptoms of
Inadequate CHO Intake
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1. Fatigue
2. Dehydration
3. Energy Loss
CHO are stored for around 24 hours
*If CHO are lacking then:
1. Protein catabolism begins only after a
few hours rather than using protein for
healing
2. Fat tissue is broken down with release
of fatty acids, glycerol & ketone bodies
which means fats burn incompletely &
acidosis occurs. *Glucose is required for
complete oxidation of fats.
CHO: Signs & Symptoms of
Inadequate CHO Intake (con’t)
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As long as glucose is present, ketones are
quickly metabolized by muscle tissue so that
ketone levels of the blood remain unchanged.
Pts. with Ketoacidosis have excessive ketone
bodies in the blood. They exhibit
hyperventilation, loss of Na, K+, Cl- and H2O
form the body.
Excessive glucose is converted to glycogen
until this limited glycogen storage capacity is
filled (50-75gm) simultaneously glucose is
also converted into fats & stored as adipose
tissue.
Normal Blood Glucose Level:80 – 120 mg/dl
Factors that affect how much CHO are
available for the body to use:
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1. State of mucous membrane of GI tract:
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2. Hormones:
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i.e.: intestinal disease or hypermotility (Diarrhea)
This limits or alters contact with CHO to intestinal
wall for absorption
i.e.: Insulin, Glucagon (from pancreas) & epinephrine
(from adrenal glands)
3. Vitamins: especially “B” complex are
involved in the metabolism of CHO
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B1 – Thiamin, B2 – Riboflavin, B3 – Niacin
*** Remember TRN 123 Temporary Registered Nurse
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CHO are Protein sparing:
 If CHO are present in adequate
amounts you don’t use protein for
energy.
Need 100g/day to prevent this
CHO’s prevent formation of ketones
(Ketoacidosis):
 if CHO decreased (starvation,
diabetes)
 excess fat is oxidized and therefore
increases ketones
Energy from CHO is in the form of:
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Heat
Muscle
contraction
Synthesis of
essential
compounds
Conduction of
nerve impulses
Health Problems & CHO’s
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Dental caries
Obesity
Hypoglycemia/
Hyperglycemia
Alcohol blocks
glucose
production by
the liver
Lipids -- Fat
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Classified
According to
three Criteria:
1. Whether the
fat is emulsified
or nonemulsified
2. Visible or
invisible
3. Simple or
Compound
Lipids – Fat (con’t)
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The term Emulsion is applied
to a liquid dispersed in another
liquid with which it does not
usually mix.
i.e.: Oil and Vinegar do not
mix
Fat is insoluble in H2O
A means of transporting fat
thru the water based blood is
a problem.
So the body must emulsify
dietary fat.
This occurs in the small
intestine thru the action of bile
salts (from liver to GB)
Visible vs. Invisible
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Visible Fat: 40%
Easily seen
on meat
Oil
Butter
Invisible Fat:
Hidden in foods
Egg yolk
Baked goods
Snacks
Emulsified milk
Cheese
Olives
Nuts
Avocados
Simple vs Complex
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Lipids in foods and in the human
body fall into 3 classes:
1. Triglycerides (simple) – 95%
2. Phospholipids – ex. Lecithin
3. Steriods – ex. Cholesterol
Blood lipids, cholesterol, fats & oils
all contribute to health and detract
from it.
Fats Provide:
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1. Energy – for now & stored fat for
later energy
2. Insulation – Maintaining body temp
& padding (protecting organs)
3. Cell membrane integrity
4. Nerve impulse transmission
5. Carries fat soluble vitamins (ADEK)
Taste (satiety) – Adds texture & flavor
to foods
Usefulness of Fats
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In Foods:
 Makes foods taste better
 Taste, smell, feel full
 Provide essential fatty acids
 Provide energy
 Carry fat soluble vitamins
In Body:
 Insulation
 Padding
 Energy
 Cell membrane material
Fatty Acids
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Saturated:
Unsaturated:
One whose
Has at least one
structure is
unfilled H+ spot
completely
Monounsaturated
filled with all
vs
H+ it can hold
Polyunsaturated
Heavier, more
The more unsat.
dense,more solid the more liquid
Requires higher
at room temp.
Temp. to melt
Monounsaturated Fatty Acid
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Usually Plant Origin
Liquid at Room Temp
Can Become
saturated if a
chemical change
occurs
Foods: Peanuts,
Peanut oil, Olives &
Olive oil, Almonds,
Pecans, Canola oil
Polyunsaturated Fatty Acids
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Plant Origin
Liquid at Room
Temp.
Foods: Veg. Oils
Sunflower oils
Some margarines
French Dsg.
Walnuts
Trans-Fatty Acids
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Have implications for the body’s
health
Not currently mentioned on food
labels
Carry a risk similar to saturated
fats
Elevated blood cholesterol &
thus raise the risk of heart
disease & heart attack
Are found in fast foods, chips,
baked goods, & other
commercially prepared foods
High in fats can contain up to
50% trans-fatty acids
Chemical Digestion Fat Begins
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Mouth -> via chewing -> smaller parts & warms
food
Stomach -> Fats emulsified due to Gastric
lipase & peristalsis
Small Intestine ->
 Bile Salts: Fat in duodenum -> releases of
cholecystokinin > causes GB to contract >
releases bile
 Bile: 20-60 ml held in Gallbladder,
produced in liver
 Enzymes: pancreatic lipase & enteric lipase
End Products: Monoglycerides, Fatty acids,
Glycerol
Blood Lipid Profile
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Triglycerides: <100
mg/dl desired
Cholesterol: <200mg/dl
200-239 Borderline
CVD. > 240 ^ risk
Lipoproteins:
HDL – High density –
good
29-77 mg/dl
Carry cholesterol away
from cell
LDL Low density – bad
62-185 mg/dl
Carry cholesterol to cell
The Good , Bad & The Ugly Cholesterol
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Important in structure of
brain & nerve cells
Nonessential nutrient
Endogenous supply
1000mg/day
Take in more > Body
makes less
Major contributor of plaque
<200 mg/dl
Keep intake <300mg/day
Cholesterol – Food Sources
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Egg Yolk
Organ meats (especially
liver & kidney)
Cream
Butter
Ice Cream
Cheese* ( The lighter in
color the lower the
amount of cholesterol)
Remember – if it had or
has a heart beat, it has
cholesterol
What about Fat Substitutes?
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“O’lean”, Olestra
O’lestra: is indigestible
therefore the body has no way
to take it apart
Problems: causes digestive
distress & nutrient losses
i.e.: gas, diarrhea, cramping,
strong “urge to go”
Oil can leak thru feces & leak
from the anus
May interfere with absorption
of fat soluble vitamins
Proteins –
The Most Expensive Nutrient
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Proteins are the
building blocks of
blood and bone & all
other tissues. They
are the structural part
of every cell.
They are made up of
smaller building blocks
called amino acids.
Found in scar tissue,
hair growth, blood
albumin, Hemoglobin
More on Proteins
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Chemical elements –
C, H, O2 & Nitrogen
Linked together by
peptide bonds
50,000 different
proteins
24 Amino Acids
Change the number or
arrangement you
change the Amino Acid
Essential vs
Nonessential
4 Major Functions in Body
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1. Maintenance
of Growth
2. Regulation of
Body Process
3. Development
of Immunity
4. Energy
Amino Acids
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Essential:
Means they cannot be
manufactured by body & must
be obtained from food
9
All 9 must be available
simultaneously & in sufficient
quantities for synthesis of body
proteins
Nonessential:
Can be synthesized by body
Often derived from other amino
acids
Complete vs Incomplete Protein Foods
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Complete:
Have all 9 Essential Amino
Acids
Examples: Meat, Eggs, &
Milk
Incomplete:
Lack some Amino Acids
Some foods mixed together
= a complete protein food
Examples:
Corn & peas
Spaghetti Noodles & cheese
Milk & cereal
Rice with pork
Noodles with tuna
Keeping a Positive Nitrogen Balance
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Protein Balance: The body’s tissue
proteins are constantly being broken
down into amino acids, a process called
catabolism & the resynthesized into
tissue proteins as needed , a process
called anabolism.
To maintain Nitrogen balance, the
Nitrogen containing element of the amino
acids can be removed by a process called
deamination – converting to ammonia
(NH3) & the Nitrogen is excreted as urea
in the urine.
Keeping a Positive Nitrogen Balance
(con’t)
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A positive nitrogen balance exists when
nitrogen intake exceeds output, that is
when protein anabolism exceeds protein
catabolism.
A negative nitrogen balance exists when
nitrogen output exceeds intake. This
state usually occurs when a person does
not consume adequate essential amino
acids & or calories, is immobilized, or is
exposed to unusual stress as a result of
trauma. To prevent this a person must
ingest at least 20-30 gms of protein each
day.
Protein Metabolism
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Mouth -> chopping into smaller parts
Stomach -> Chemical digestion begins
with help of: Pepsin, HCL, & Rennin
Small Intestines -> Digestion is completed here
Pancreatic Secretions:
Intestinal Secretions:
Ex: Tryosin
Ex: Ainopeptidase
Chymotrypsin
Dipeptidase
Carboxypeptidese
Absorption occurs thru lining of small intestines
with help of Na
End Products: H2O – Urea – CO2 > Liver
Lab Values - Protein
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Albumin accounts for >50% of total protein &
therefore reflects the protein status of blood
& organs.
Albumin levels: 3.5-5 g/dl or 35-45 gms
Albumin levels increase & decrease slowly
therefore when decrease serum albumin is
seen associated with malnutrition, it reflects
prolonged protein depletion.
Other conditions that show decreased
albumin levels are, liver & kidney disease,
AIDS, Ca, & burns.
Daily Allowances of Protein
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Based on age & desired
weight
Newborn: 2.2 gm/kg
7-10: 1.2 gm/kg
Adolescent: 1 gm/kg
Adult: 0.8 gm/kg
A man weighing 154 lbs. =
56 gm of daily protein
Food examples:
7 inch carrot = 1 gm
protein
1 small raw tomato = 1
gm of protein
Egg = 6 gm of protein
Meat = 7 gm/ounce
Milk = 9 gm/cup
Water – H20
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Must be consumed often & in
greater quantities
Solvent in which chemical
reactions occur
Medium for transporting
substances. Ex: Blood, Lymph,
Waste
Provides lubrication. Ex:
Synovial fluid & mucous
Contributes turgor to cells
Regulates body temperature
via Evaporation
Which food are high?
Micronutrients - Vitamins
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Fat Soluble: A, D, E, K
 Stored in the body
 Stable in heat
 No nitrogen
 Require bile for absorption
 Soluble in fats
Water Soluble: C, B Complex
 Soluble in water
 May be affected by cooking
methods
 B Complex contain Nitrogen
 Very little stored therefore
few toxic levels occur
Minerals
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Minerals, or elements: are inorganic
substances
Required in small amounts
Cannot be synthesized in the body, must be
obtained from food
Some are important constituents of bones
(Ca), others are required to activate specific
enzymes involved in chemical reactions, to
maintain acid-base balance (Mg, P, Na, Cl) &
water balance (K, Cl) & muscle functions (Mg,
K, Na, Ca).
Approx. 3-6% of the body weight is made up
of minerals (ash). Minerals should be supplied
daily because they are excreted every day by
the kidneys, bowel, & skin.
Minerals are stored!
Minerals (con’t)
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Minerals are found in organic compounds or
inorganic compounds & as free ions.
Upon oxidation, minerals leave an ash, which
can be acid or alkaline.
Ca & P make up 80% of all mineral elements
in the body.
There are 2 categories:
Macrominerals: These are minerals people
require daily in amounts> 100 mg. Ex: Ca, P,
Na, K, Mg, Cl
Microminerals: are those that people require
daily in amounts < 100 mg. Ex: Fe, Zn, I, F.
Nutrition
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Nutritional status is
determined:
By what & how
much the individual
eats
By his or her’s body
ability to use
nutrients
By the state of the
person as a result of
the intake of
nutrients
Consider the following when assessing
Nutritional Status
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1. Anthropometric
measurements: Ht,
Wt, Skin folds, Arm
Circumference
2. Dietary History
3. Clinical signs of
poor nutrition
4. Energy Level
5. Factors Affecting
Caloric Requirements Vary R/T
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Age & Growth: Growth > calorie
Sex: Men have ^ BMR due to
muscles, Pregnancy ^
Climate: Colder > BMR
Health/Illness: ^ Temp. = ^ BMR,
Malnutrition = Decreased BMR
Sleep
Type food consumed
Activity - ^ = ^BMR
Factors Affecting Eating
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Culture
Religion
Socioconomic
Personal
Preference –
Childhood
Emotions
Health
Religious Considerations
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Jewish:
Don’t mix meat &
dairy products at
the same meal
Prohibited Foods:
All products
obtained from
pigs: i.e.: pork,
bacon, ham,
animal shortening,
marshmallows
(gelatin)
Religious Considerations (con’t)
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Catholic:
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Seven-Day Adventist:
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Prohibited Foods: Pork products & shellfish
Alcoholic beverages
Church of Jesus Christ of the Latter-Day
Saints (Morman):
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Abstain from eating meat & from eating between
meals on Ash Wednesday & Good Friday
Observe periods of fasting
Alcoholic beverages
Christian:
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Alcoholic beverages
Do You Know Your Numbers?
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Calculate BMI:
 Take Wt x 704 = A
 Take Ht inches x Ht inches = B
 A divided by B = BMI
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Ideal -> 20 – 25:
 Lowest risk for obese diseases (CV,
Diabetes, & Stroke)
25-30: Overweight
> 30: Obese (Increased risk for the “3”)
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How about IBW
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Nursing Interventions to Encourage
Nutrient Intake
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Assess situation: Foods, History,
Health Issues, etc.
Provide Foods they like
Consult with Registered Dietician
Environmental Changes
Consider Medical Treatment: Meds
around meals
Food Pyramid Guide
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MILK Products: 23 *Serving is 1
cup (8oz)
FRUIT: 2-4
VEGETABLES: 3-5
BREADS &
CEREALS: 6-11
MEAT/FISH: 2-3 *
Serving is 2-3 oz.
Factors to Consider When Planning a
Meal
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Include all of the food groups
Variety: Color, Texture, Flavor,
Shape, Satiety, *Don’t
overemphasis one food group
Sociologic & personal preference
Time & Energy
Appearance
Economical fuel usage
Food cost
Common Therapeutic Diets
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Regular
Liquids: Full vs
Clear
Soft
Low Residue
Low Fat
Low Carbohydrate
Diabetic
Calculating I & O:
Do You Know Your Sources?
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Intake:
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Oral Fluids: H2O, Coke,
Tea
Ice chips
Food (Liquid @ room
temperature)
Tube Feedings
IV Fluids
Irrigants
Blood
Calculating I & O:
Do You Know Your Sources? (con’t)
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Output:
 Urinary
 Vomitus
 Liquid Feces
 Tube Drainage
 Wound Drainage
 Fistula Drainage
 Rapid Respirations
 Diaphorsis
Parenteral Therapy
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Intake
Equipment:
IV Bag
Drip Chamber
Tubing
Roller Clamp
*Dial-a-Flow
*Infusion Pump
Ways to control Volume of Fluid to
Patients
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IV Pumps
Solusets
Dial-a-Flow
Setting the correct rate on the
pump
Counting the number of drops in the
drip chamber
Assessing the patient frequently
Complications from IV Therapy
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Hematoma: Collection
of blood
Phlebitis: Inflammation
of vein
Infiltration: Seepage of
fluid into the tissue
rather than vein
Prevention:
Frequent assessment
Antiseptic ointment at
site
Changing lines per
hospital protocol ( q 72
hours)
Insertion of a Nasogastric Tube for
Suction or Feeding
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Have you collected ALL your supplies?
What position do you need to place your
patient? High Fowlers
Which nostril should I use?
How far do I insert the tube? Measure
During insertion:
 What do I tell my patient.
 What should they be doing?
 What technique should I be doing?
Do they stay in the same position the
whole time?
The Tube is in, Now what do I do?
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1. Check for placement,
but how?
 A. Instill 10cc air while
you listen.
 B. Aspirate stomach
contents & check the pH
 C. Chest X-ray if
possible.
2. Be sure they can speak.
3. Secure with tape to
nose & provide comfort
measures.
4. Connect to feeding or
suction.
pH of Secretions



Yellow-Green: is pH of 1-4 = Acidic
in Gastric Secretions
Golden Yellow: is pH of 6.5 =
Intestinal Secretions
Color change toward blue: Is pH
7.0-8.0 = Lungs and a more
alkaline pH