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Fundamentals of Nursing:
Standards & Practices, 2E
Chapter 38
Nutrition
Physiology of Nutrition
Nutrition is the process by which
the body metabolizes and utilizes
nutrients.
Nutrients are classified as energy
nutrients, organic nutrients, and
inorganic nutrients.
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Energy nutrients release energy for
maintenance of homeostasis.
Organic nutrients build and maintain
body tissues and regulate body
processes.
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Inorganic nutrients provide a
medium for chemical reactions,
transporting materials, maintaining
body temperature, promoting bone
formation, and conducting nerve
impulses.
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Digestion
• The mechanical and chemical process
that converts nutrients into a physically
absorbed state is digestion.
• Mastication is the chewing, tearing, or
grinding of food by the teeth into fine
particles and then mixing with enzymes
in saliva.
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• Deglutition is the swallowing of food.
• Peristalsis is the coordinated,
rhythmic, serial contraction of the
smooth muscle lining of the intestines.
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Absorption
• The process by which the end products
of digestion(monosaccharides (simple
sugars), amino acids, glycerol, fatty
acid chains, vitamins, minerals, and
water) pass through the epithelial
membranes in the small and large
intestines into the blood or lymph
systems is known as absorption.
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• The part of the food that body enzymes
cannot digest and absorb is known as
dietary fiber.
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Metabolism
• Metabolism is the aggregate of all
chemical reactions and process in
every body cell, such as growth,
generation of energy, elimination of
wastes, and other bodily functions as
they relate to the distribution of
nutrients in the blood after digestion.
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• The breakdown of glucose by enzymes
located inside the cell’s cytoplasm is
known as glycolysis.
Energy
• The rate of heart liberation during
chemical reactions is known as
metabolic rate.
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• Calories are used to express the
quantity of energy released from
different foods or expended by different
functional processes of the body.
• Basal metabolic rate (BMR) refers to
the energy needed to maintain
essential physiological functions.
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Excretion
• Excretory organs are the kidneys,
sweat glands, skin, and lungs.
• Digestive and metabolic waste
products are excreted through the
intestines and rectum.
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Nutrients
Water
• Water is the most abundant nutrient in
the body and accounts for 60% to 70%
of an adult’s total body weight and 77%
of an infant’s weight.
• Water and electrolytes are substances
that must be acquired from the diet.
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• The body maintains a balance between
the amount of fluid taken in and the
amount excreted.
Vitamins
• Organic compounds that are needed in
small quantities for operation of normal
bodily metabolism and that cannot be
manufactured in the cells of the body
are vitamins.
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• Fat-soluble vitamins require the
presence of fats for their absorption
from the GI tract, and for cellular
metabolism.
• Water-soluble vitamins require daily
ingestion because they are not stored
in the body.
• Review Table 38-1 Fat-Soluble and
Water-Soluble Vitamins.
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Minerals
• Minerals serve as catalysts in
biochemical reactions.
• Minerals are classified according to
their daily requirement: macrominerals
(quantities of 100mg or greater) and
microminerals (trace elements,
quantities less than 100 mg).
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Carbohydrates
• Organic compounds composed of
carbon, hydrogen, and oxygen are
known as carbohydrates.
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• Carbohydrates are classified according
to the number of saccharides (sugar
units).
 Monosaccharides (simple sugars)
include glucose, galactose, and fructose.
 Disaccharides (double sugars) include
sucrose, lactose, and maltose.
 Polysaccharides (complex sugars)
include glycogen, cellulose (fiber), and
starch.
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• Glucose provides the major source of
energy needed for cellular activity.
• Triglycerides and proteins are
metabolized to produce energy when
dietary intake is below minimum
requirements.
• Three major sources of dietary
carbohydrates are starches, lactose,
and sucrose.
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• Insulin aids in the diffusion of glucose
into the liver and muscle cells and in
the synthesis of gylcogen.
• Hyperglycemia is caused by an
increase in blood glucose levels.
• Hypoglycemia is caused by blood
glucose levels that are below normal.
• Review Table 38-2 Normal Function
and Deficiencies of Selected Nutrients.
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Proteins
• Organic Compounds that contain carbon,
hydrogen, oxygen, and nitrogen atoms
are known as proteins.
 End product of digestion are amino acids.
 Nonessential amino acids can be
synthesized in the cells.
 Essential amino acids must be ingested
in the diet because they cannot be
synthesized in the body.
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• Proteins are also classified as
complete or incomplete.
 High-biological-value proteins
(complete proteins) contain all the
essential amino acids.
 Low-biological-value proteins
(incomplete proteins) lack one or more
essential amino acids.
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• Deamination begins the process of
degradation of amino acids.
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Gluconeogenesis, the conversion of
amino acids into glucose or glycogen.
Ketogenesis, the conversion of amino
acids into keto acids or fatty acids.
Nitrogen balance, the net result of intake
and loss of nitrogen that measures protein
anabolism and catabolism.
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Positive nitrogen balance, the condition
that exists when nitrogen intake exceeds
output (protein anabolism exceeds
anabolism).
Negative nitrogen balance, the condition
that exists when nitrogen output exceeds
intake (protein catabolism exceeds
anabolism).
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
Obligatory loss of proteins, the
degrading of the body’s own proteins into
amino acids, which are then deaminated
and oxidized (occurs when a person fails
to ingest adequate amounts of proteins).
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Lipids
• Lipids (fats) are organic compounds
that are insoluble in water but soluble
in organic solvents, such as ether and
alcohol.
• Fatty acids are the basic structural
unit of most lipids.
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• Saturated fatty acids form fats,
glycerol esters of organic acids whose
carbon atoms are joined by single
bonds.
• Unsaturated fatty acids form glycerol
esters of organic acids whose carbon
atoms are joined by double or triple
bonds.
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• Monounsaturated fatty acids are
fatty acids that form esters with one
double or triple bond.
• Polyunsaturated fatty acids form
esters that have many carbons
unbonded to hydrogen atoms.
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The most popular lipids
• Triglycerides are lipid compounds
composed of three fatty acid cells
attached to a glycerol molecule.
• Phospholipids are composed of one
or more fatty acid molecules and one
phosphoric acid radical, and usually
contain a nitrogenous base.
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• Cholesterol is considered a fat and is
found in whole milk and egg yolk.
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Promoting Proper Nutrition
Dietary Reference Intakes and
Recommended Daily Allowances
The Food Guide Pyramid
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Weight Management
Societal Concerns
Overweight is an energy imbalance
in which more food is consumed
than needed.
Underweight is when more calories
are expended than consumed.
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• Anorexia nervosa (self-starvation)
disrupts metabolism because of
inadequate calorie intake.
• Bulimia nervosa refers to foodgorging binges followed by purging of
food.
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Factors Affecting Nutrition
Age
Lifestyle
Ethnicity, Culture, and Religious
Practices
Other Factors
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Assessment
Nutritional History
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24-Hour Recall
Food-Frequency Questionnaire
Food Record
Diet History
Review Table 38-3 on health history
related to nutrition and metabolism.
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Physical Examination
• Intake and Output (I&O)
• Anthropometric Measurements
• Review Table 38-4 on adult physical
assessment findings: nutrient balance
• Review Table 38-5 on adult growth
chart
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Diagnostic and Laboratory Data
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Protein Indices
Hemoglobin Level
Total Lymphocyte Count
Nitrogen Balance
Urine Creatinine Excretion
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Nursing Diagnosis
Imbalanced Nutrition: Less Than
Body Requirements
Imbalanced Nutrition: More Than
Body Requirements or Risk for More
Than Body Requirements
Other Nursing Diagnoses
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Outcome Identification and
Planning
Planning focuses on promoting
optimal nutritional care.
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Implementation
Monitoring Weight and Intake
Initiating Diet Therapy
Assistance with Feeding
Providing Nutrition Support
Providing Enteral Nutrition
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Review Procedure 38-1 on inserting
a nasograstric or nasointestinal tube
for suction and enteral feedings.
Review Procedure 38-2 on
administering enteral tube feedings.
Providing Parenteral Nutrition
Administering Medication through a
Feeding Tube
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Evaluation
Use current data to measure
achievement of goals and outcomes.
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