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Nutrition – Chapter 30
Learning objectives
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Identify nutrition and fluid intake
and output requirements across the
lifespan
Describe nutrition and fluid balance
Identify types of nutrients
Explain roles of nutrients in the
body
Identify food sources for nutrients
Learning objectives
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Explain types of therapeutic diets
Explain the relationship of
prescribed diet to nutritional/fluid
balance
Identify equipment for measuring
nutrition and fluid intake and output
Calculate nutritional/fluid intake and
output
Learning objectives
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Define enteral feedings
Explain the procedure for initiating
enteral feedings and equipment
used
Nutrition – You Are What You Eat
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Nutrition – the food you eat and
how your body uses it
Nutrients – chemical substances
supplied by food that the body
needs for growth, maintenance and
repair
Macronutrients – carbohydrates,
fats, and proteins
Nutrition
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Nutritional status is
determined:
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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
Factors Affecting Eating
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Culture
Religion
Socioeconomic
Personal
Preference
Childhood
Emotions
Health
Diet & Illness
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Some of our nation’s
top leading causes of
death have been
associated with diet:
Coronary heart disease
Certain types of cancer
Stroke
Diabetes
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
Nutrients
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CHO, fats are well known as fuel
foods – but protein is sometimes
forgotten
CHO – 4Kcal/gm
FAT – 0 Kcal/gm
Protein – 4 Kcal/gm
Simple vs Complex Carbohydrates
Simple:
 Monosaccharides:
 Glucose, fructose,
galactose
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Simple CHO
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Disaccharides :
Double sugar
Sucrose,
maltose, lactose
W & B Sugar,
molasses,
honey, sweet
potatoes,
pineapples,
carrots
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
Lipids -- Fat
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Classified
According to
three Criteria:
Whether the fat
is emulsified or
nonemulsified
Visible or
invisible
Simple or
Compound
Visible vs. Invisible Fats
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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
Fats Provide:
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Energy
Insulation
Cell membrane integrity
Nerve impulse transmission
Carries fat soluble vitamins (ADEK)
Taste (satiety)
Fatty Acids
 Saturated:
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One whose
structure is
completely
filled with all
H+ it can hold
Heavier, more
dense,more solid
Requires higher
Temp. to melt
Unsaturated:
Has at least one
unfilled H+ spot
Monounsaturated
vs
Polyunsaturated
The more unsat.
the more liquid
at room temp.
Monounsaturated Fatty Acid
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Usually of 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: Vegetable
Oils, Sunflower
oils, some
margarines, french
dressing, walnuts
Trans-Fatty Acids
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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
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
Cholesterol – Food Sources
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Egg Yolk
Organ meats
(especially liver &
kidney)
Cream
Butter
Ice Cream
Cheese
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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Building blocks are
amino acids
Structural part of
every cell
Four major functions of protein in the
body
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Maintenance of
Growth
Regulation of
Body Process
Development of
Immunity
Energy
Amino Acids
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Essential: (9)
Means they cannot be
manufactured by body &
must be obtained from
food
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
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
Dietary Fiber
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Insoluble:
Incapable of being
dissolved
Fruits and vegetable
skins, nuts, popcorn
Promote bowel
regularity
Water – H20
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Must be consumed often
& in greater quantities
Solvent in which chemical
reactions occur
Medium for transporting
substances.
Provides lubrication
Contributes turgor to cells
Regulates body
temperature
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 contains
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.
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
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
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
Use variety: Color, Texture, Flavor,
Shape, Satiety,
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
Low sodium
High fiber
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
 Diaphoresis
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
Phlebitis
IV Care
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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?
Bolus vs Continuous enteral feeding
Measurement for NG tube
The Tube is in, Now what do I do?
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1. Check for placement,
but how?
 A. Auscultation
 B. Aspiration
 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
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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
Nutrition…Critical Thinking
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Utilize Scientific
and Nursing
Knowledge to
interpret and
analyze data.
Identify nursing
diagnosis and
implement care.
Nutrition…Nursing Process
Assessment
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Anthropometry
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Body fat, body mass
index, ideal body
weight, height
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Dietary History and
Health History
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24 Hr recall
Food patterns
Culture,socioeconomi
c
Medications
Laboratory
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Complete Blood
Count
Serum Albumin
Serum iron
Lymphocyte Count
Physical Exam
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Skin, hair, nail,
mucous
membrane,
swelling
Nutrition…Nursing Process
Nursing Diagnoses
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Aspiration, risk
Breastfeeding, ineffective
Constipation/Diarrhea
Fluid volume deficit/excess
Knowledge deficit
Self-care deficit (unable to feed
self)
Skin integrity, altered
Nutrition…Nursing Process
Planning
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Plan optimum
nutrition, improve
or reduce the
problem, through
appropriate
nursing
interventions.
Nutrition…Nursing Process
Implementation
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Health Promotion
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Teaching proper
diet, good nutrition
habits
Food preparation
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Feeding Patients
with Dysphagia
Diets
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Clear,full, pureed,
mechanical soft,
soft, regular
Enteral Feeding
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Insertion
Site Care
Patency/Flushing
with water
Check for
placement
Trouble shooting
Feedings –
Formula
Nutrition…Nursing Process
Implementation-2
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Enteral Feeding
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Bolus or Intermittent Feeding
Continuous
 Feeding bag and IV pole; infusion pump
Parenteral Nutrition – lipids, glucose,
amino acids, vitamins, minerals
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Gradual increase and gradual reduction to stop
Complications-air embolus, infection, abnormal
levels
Nutrition…Nursing Process
Implement/Medical Nutrition
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Gastrointestinal Disorders
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Peptic ulcer – no caffeine, spicy foods
Crohn’s –fiber, vitamin, iron supplements
Celiac-gluten free diet
Diverticulitis –low residue
Diabetes Mellitus –complex carbohydrates
Cardiovascular-fat, sodium, cholesterol,
K+
Pulmonary-fluids, macronutrients
Nutrition…Medical Therapy (contd)
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Renal – chronic – fluid, sodium, K+,
protein, phosphate.
Cancer –diet to meet nutritional
deficits cause by treatment.
HIV – individualized based on
nutritional needs.
Nutrition…Nursing Process Evaluation
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Incorporate dietary changes into his
lifestyle with least amount of stress
or disruption to client and ensure
outcomes are met.
Increase diet knowledge, promote
optimum nutrition.
Nutrition…Summary
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Nutrition – basic
human needs.
Knowledgeable about
elements of nutrition.
Utilize knowledge in
meeting nutritional
needs/diets for
optimum nutrition.