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Transcript
NUTRITION
Nursing Implications
1
Nutrition
• All of the processes involved in consuming
and utilizing food for energy, maintenance,
and growth.
Physiology of Nutrition
Five processes are involved in the body’s use of
nutrients:
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Ingestion.
Digestion.
Absorption.
Metabolism.
Excretion.
Ingestion
• The taking of food into the digestive tract,
generally through the mouth.
Digestion
• The mechanical and chemical processes that
convert nutrients into a physically absorbable
state. Digestion includes:
– Mastication (chewing).
– Deglutition (swallowing).
– Peristalsis (coordinated, rhythmic, serial contractions of
the smooth muscles of the GI tract).
Absorption
• The process by which the end products of
digestion pass through the small and large
intestines into the blood or lymph systems.
Metabolism
– The body’s conversion of nutrients into
energy.
– Basal metabolism is the amount of energy
needed to maintain essential physiologic
functions when a person is at complete
rest, both physically and mentally.
Excretion
– The process of eliminating or removing
waste products from the body.
The Six Essential Nutrients
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•
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Water
Carbohydrates
Fats
Proteins
Vitamins
Minerals
Water
• The Most Important Nutrient.
• Daily requirements: 1,000mL of water to
process 1,000kcal eaten.
Functions of Water
• Solvent (dissolves
substances to form
solutions).
• Transporter (carries
nutrients, wastes, etc.
throughout the body).
• Regulator of body
temperature.
• Lubricant (aids in providing
smooth movement for
joints).
• Component of all cells.
• Hydrolysis (breaks apart
substances, especially in
metabolism).
Classification & Sources
of Water
• Liquids consumed (water, coffee, juice, tea,
milk, soft drinks).
• Foods consumed (especially fruits and
vegetables).
• Metabolism (produces water when
oxidization occurs).
Water: Digestion, Absorption and
Storage
• Water is not digested. It is absorbed and used by
the body as we drink it. It cannot be stored by the
body. The body loses water in four ways:
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Urine.
Feces.
Perspiration.
Respiration.
Water: Signs of Deficiency
• Abnormal water losses include profuse
sweating, vomiting, diarrhea, hemorrhage,
wound drainage (burns), fever, and edema.
• A deficiency of water is called dehydration.
Prolonged dehydration results in death.
Carbohydrates
• The chief source of energy for the body.
Made up of carbon, hydrogen, and oxygen.
They are the major source of food for all
people.
• Daily requirements: 50% to 60 of an
individual’s kcal intake per day.
Functions of Carbohydrates
Carbohydrates are...
• The primary source of energy for the body.
• Spares proteins from being used for energy, thus allowing
them to perform their primary function of building and
repairing body tissues.
• Needed to oxidize fats completely and for synthesis of fatty
acids and amino acids.
Carbohydrates: Classification and
Sources
• Carbohydrates may be simple or complex.
• Simple are single or double sugars.
• Complex are composed of many single sugars
joined together (starch, dietary fiber,
glycogen).
Carbohydrates: Digestion, Absorption
and Storage
• Digestion of cooked starches begins in the
mouth.
• Little digestion occurs in the stomach.
• Carbohydrate digestion completed in the
small intestine.
• Carbohydrates are used completely, leaving
no waste for the kidneys to excrete.
Carbohydrates: Signs of Deficiency
• Mild deficiency can result in weight loss and
fatigue.
• Serious deficiency can result in ketosis.
Fats
• The most concentrated source of energy in
the diet. An essential nutrient, but too much
can be a health hazard.
• Daily requirements: should not exceed 25%
to 30% of an individual’s caloric intake per
day.
Functions of Fats
• Provides concentrated source of energy.
• Assists in absorption of fat-soluble vitamins.
• Is a major component of cell membranes and myellin
sheaths.
• Improves flavor of foods and delay’s stomach’s emptying
time.
• Protects and hold organs in place.
• Insulates body, thus assisting in temperature maintenance.
Classification of Fats
• Triglycerides (true fats).
• Phospholipids (lipoids, composed of glycerol,
fatty acids, and phosphorus).
• Cholesterol.
Sources of Fats
• Animal (lard, butter, milk, cream, egg yolks,
and fat in meat, poultry, and fish).
• Plant (oils from corn, safflower, peanut, palm,
etc., as well as nuts and avocado).
Digestion, Absorption and Storage of
Fats
• No chemical breakdown of fats occurs in the
mouth and very little in the stomach.
• Digestion occurs in small intestine.
• Fats not immediately needed by the body are
stored as adipose tissue.
Fats: Signs of Deficiency and Excess
• Deficiency occurs when fats provide less than
10% of daily kcal requirement.
• Gross deficiency may result in eczema,
retarded growth, and weight loss.
• Excess fat consumption can lead to
overweight and heart disease.
Proteins
• The only nutrient that can build, repair, and
maintain body tissues.
• Daily requirements: determined by size, age,
gender, and physical and emotional conditions.
• Daily protein requirement for average adults
is 0.8g for each kilogram of weight.
Functions of Proteins
• To provide amino acids necessary for synthesis of body
proteins, used to build, repair, and maintain body tissues.
• To assist in regulating fluid balance.
• Used to build antibodies.
• Plasma proteins help control water balance between the
circulatory system and surrounding tissues.
• In event of insufficient stores of carbohydrates and fats,
protein can be converted into glucose and used for energy.
Classification & Sources of Proteins
• Complete proteins contain all 9 essential
amino acids. (All animal fats, except for
gelatin, are complete. Only plant fat that is
complete is soybeans).
• Incomplete proteins have one or more
essential amino acids missing (plant
proteins).
Digestion, Absorption and Storage of
Protein
• Digestion begins in the stomach.
• Most digestion takes place in the small
intestine.
• Amino acids not used to build proteins are
converted to glucose, glycogen, or fat and are
stored.
Signs of Deficiency and Excess of
Protein
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Muscle wasting.
Edema (swelling).
Lethargy and depression.
Excess can result in heart disease, colon
cancer, osteoporosis.
Vitamins
• Essential organic compounds that regulate
body processes and are required for
metabolism of fats, proteins, and
carbohydrates.
• Needed in very small amounts.
BODY WEIGHT/BODY MASS
• Ideal body weight
• Body mass index
• Percent body fat
32
FACTORS AFFECTING NUTRITION
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Development
Gender
Ethnicity & culture
Beliefs about food
Personal preferences
Religious practices
Lifestyle
Medications & therapy – table 45-1
33
FACTORS AFFECTING NUTRITION
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Health
Alcohol abuse
Advertising
Psychologic factors
34
NUTRITION THRU THE
LIFE CYCLE – Young & Middle Adult
• Lay foundation for lifetime nutrition pattern in young
adulthood
• Nutrient requirements change very little
• Females need to maintain/increase intake of Vit. C ,
Vit D, & calcium; & maintain intake of iron
• Basal metabolism decreases 2-3%/decade after age
25
• Obesity, HTN , & DM may begin to form
35
NUTRITION THRU THE
LIFE CYCLE – Older Adults
•
•
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•
Physiologic, psychosocial, economic changes
Need fewer calories
Nutrient requirements basically the same
Variety & nutrient dense foods; water
36
Factors Affecting Nutrition:
Ethnicity & Culture
• Native American
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Starches: corn, rice
Fruits: berries
Veggies: rhubarb, mushrooms, roots
Meats: game, seafood, nuts
Milk: little used
• High incidence of lactose intolerance
• Encourage broiled, poached, steamed meats
37
Factors Affecting Nutrition:
Ethnicity & Culture
• U.S. Southern
– Starches: cornbread, biscuits, potatoes
– Fruits: melons, peaches, bananas
– Veggies: collards, okra, tomatoes, cabbage
– Meat: pork, chicken, fish
– Milk: milk, ice cream
• Many foods fried, cooked with lard
38
Factors Affecting Nutrition:
Ethnicity & Culture
• Mexican
– Starches: tortillas, corn products
– Fruits: few
– Veggies: chili peppers, tomatoes, onions
– Meat: beef, poultry, eggs, pinto beans
– Milk: cheese; rarely drink milk
39
Factors Affecting Nutrition:
Beliefs & Preferences
• Individual likes & dislikes
• Beliefs about foods
• Fad diets
40
Factors Affecting Nutrition:
Religious Practices
• Christianity
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Catholics
Eastern Orthodox
Mormons
Seventh Day Adventists
• Islam
– No pork or alcohol; daylight fasting during Ramadan
41
Factors Affecting Nutrition:
Lifestyle
• Economic & social status
• Work/activities
42
Factors Affecting Nutrition:
Medications, Therapy, & Health
• Therapies
– Chemo, radiation
• Health
– GI disorders, viruses, oral ulcers
43
Factors Affecting Nutrition:
Alcohol, Advertising, & Psych
• Alcohol
– Can depress appetite
– Abuse can lead to malnutrition (esp Vit B)
• Advertising
– May influence food choices
• Psych
– Overeat vs. don’t eat when stressed, depressed
44
DIETARY GUIDELINES
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Eat a variety of foods
Maintain or improve your weight
Be physically active every day
Eat diet low in trans fat, saturated fat, & cholesterol
Eat plenty of vegetables, fruits, & grains
Use sugars in moderation
Use salt & sodium in moderation
If you drink alcohol, do so in moderation
45
Food Guide Pyramid
Fats, oils & sweets
Use sparingly
Milk, Yogurt & Cheese
Meat, poultry, fish, dry beans, eggs & nuts
2-3 servings
Vegetables & Fruits
(2-5 servings)
Bread, cereal, rice & pasta
(6-11 servings)
FOOD GUIDE PYRAMID
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Healthy Eating Pyramid
Daily exercise & weight control
Whole grains at most meals
Vegetables in abundance
Fruits 2-3 times/day
Nuts, legumes 1-3 times/day
Fish, poultry, eggs 0-2 times/day
Dairy or calcium supplement 1-2 times/day
White rice, white bread, potatoes, pasta, sweets, red
meat, butter sparingly
• MVI for most
• Alcohol in moderation
47
ALTERED NUTRITION
• Malnutrition – lack of necessary or
appropriate food substances
– Overnutrition – caloric intake in excess of daily
energy requirements
• Overweight – BMI 26-30
• Obese – BMI > 30
• Morbid obesity – interferes with mobility or breathing
48
ALTERED NUTRITION
• Malnutrition
– Undernutrition – intake of nutrients insufficient to
meet daily energy requirements as a result of
inadequate food intake or improper digestion &
absorption of food
• Dysphagia – difficulty swallowing
• Anorexia – loss of appetite
• Protein-calorie malnutrition
49
The Nursing Process: Assessment
Two types of data:
• Subjective.
• Objective.
Subjective Data
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24-Hour Recall.
Food-Frequency Questionnaire.
Food Record.
Diet History.
Objective Data
• Body Mass Index.
• Skinfold Measurement.
• Other Measurements (e.g. Abdominal-Girth,
Mid-Upper-Arm).
• Laboratory Tests.
RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Diet history
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Chewing or swallowing difficulties
Inadequate food intake
Restricted or fad diets
No intake for 10 or more days
Inadequate food budget
Inadequate food preparation facilities
Physical disabilities
Living & eating alone
53
RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Medical history
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Unintentional wt loss or gain of 10% within 6 months
F/E imbalance
Oral or GI surgery
Dental problems
GI problems
Chronic illness
Alcohol or substance abuse
Neurologic or cognitive impairment
Catabolic or hypermetabolic condition
Adolescent pregnancy or closely spaced pregnancy
54
RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Medication history
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Aspirin
Antacid
Antidepressants
Antihypertensives
Anti-inflammatory agents
Antineoplastic agents
Digitalis
Laxatives
Diuretics
Potassium chloride
55
PHYSICAL EXAM
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General appearance & vitality
Weight
Skin
Nails
Hair
Eyes
Lips, tongue, gums, teeth
Heart
Abdomen
Musculoskeletal
Neurologic
56
ANTHROPOMETRIC MEASUREMENTS
• Height & weight
• Skinfold measurements – tricep most common
site
57
LABORATORY DATA
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Albumin & pre-albumin
Transferrin
Hgb
BUN
24 hour urine
Total lymphocyte count
58
DIAGNOSING
• Altered nutrition: more than body requirements
• Altered nutrition: less than body requirements
• Altered nutrition: risk for more than body
requirements
• Fluid volume excess, fluid volume deficit, & risk for
fluid volume deficit
• Activity intolerance
• Constipation
• Risk for Impaired Skin Integrity
59
PLANNING
• Client will:
– Maintain I&O balance
– Consume proper amounts of foods from variety of
food groups
– Comply with diet therapy
– Tolerate tube feedings
– Not have any complications assoc with
malnutrition
60
IMPLEMENTING - Teaching
• Use established nutritional standards
• Use visualization of serving sizes to help ID
accurate serving sizes
• Incorporate culturally based intake patterns or
restrictions
• Include client & family
• Collaborate with dietician
61
IMPLEMENTING
Special Diets
• NPO – nothing by mouth
• Clear liquid diet – water, tea, coffee, clear broths,
gingerale, plain gelatin
• Full liquid diet – clears; milk; cooked cereals,
pudding, ice cream, cream soup;
• Soft diet – easily chewed & digested
• Dysphagia – thickened liquids
• Diet as tolerated
62
IMPLEMENTING
Stimulating Appetite
• Relieve illness symptoms that depress appetite prior
to mealtime
• Provide familiar food that person likes served at
proper temp.
• Select small portions
• Avoid unpleasant or uncomfortable treatments or
activity immediately before/after meals
• Provide tidy, clean environment
• Encourage or provide oral hygiene before mealtime
• Reduce psychologic stress
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IMPLEMENTING
Assisting with Meals
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Help client feed self when possible
Assist client to sit on side of bed or chair if possible
Check tray for client’s name, type of diet, & completeness
“which order would you like to eat?”
Spread napkin, cut foods, shell egg, etc.
Do not rush client; allow ample time
Offer fluids every 3 or 4 mouthfuls of food if client unable to
communicate
• Use adaptive feeding aids as needed
• For blind person, identify placement of food as you would
describe time on a clock
64
IMPLEMENTING
Special Supplements
• Oral
– Provide calories & nutrients
– Can be liquid or powdered
– Specific types
• Tube Feeds
– When condition prevents food intake
– Impairment in upper GI tract, otherwise fx GI tract
– Increased metabolic needs that oral intake can’t meet
• Parenteral Nutrition
– IV nutrients (TPN, PPN)
65
EVALUATING
Enteral Feeds
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Daily wt
I&O
Labs
Monitor for complications
66
IMPLEMENTING
Home Care Teaching
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Preparation of formula
Proper storage of formula
Administration of feeding
Mgmt of enteral or parenteral access device
Daily monitoring needs
S/S of complications to report
Who to contact with questions/problems
67
EVALUATING
• If outcomes not achieved,
– Was cause of problem correctly identified?
– Was family included in teaching plan? Are they
supportive?
– Is client experiencing symptoms that cause loss of
appetite?
– Were outcomes unrealistic for this person?
– Were client’s food preferences considered?
– Is anything interfering with digestion or absorption of
nutrients?
68
TERIMAKASIH