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Stressors that affect Nutrition
NUR101FALL 2008LECTURE # 24K. BURGER, MSED, MSN, RN, CNE
PPP BySharon Niggemeier RN MSNRevised 12/08 J Borrero
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Nutrition• Nutrition is interaction between an
organism and the food it consumes• Food & eating is a basic need, affects
health• Various factors affect nutrition• Nutrients – substances used by the
body for growth & development• Role of nurse to teach, guide and
inform on the importance of proper nutrition
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Nursing Assessment
• Dietary intake and food preparation
• Unpleasant symptoms
• Allergies
• Taste, chewing and swallowing
• Appetite and weight
• Use of medications
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Nutritional health-care Team
• MD
• Nurse
• Social Worker
• Physical Therapist
• Occupational Therapist
• Speech Pathologist
• Pharmacist
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Essential Nutrients Regulatory Nutrients
• Water
• Carbohydrates
• Proteins
• Lipids
• Vitamins
• Minerals
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Water
• Water: present in every cell
• Absorbed in small /large intestine
• Metabolized carbohydrates, proteins, lipids produce water
• Dietary intake from fluids and solid food provide water
• Function: fluid medium needed for all chemical reactions in the body
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Carbohydrates• Carbohydrates: simple or complex
• Digested by enzymes (amylase/lactase)
• Absorbed in small intestine
• Metabolized into glucose which is used for energy or stored…Stored as either glycogen or fat
• Function: provide energy, spare proteins
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Carbohydrates (CHO)• Carbon – Hydrogen-Oxygen• 1 gram carbohydrate = 4 Kcal• Monosaccharides – simple sugars
glucose, fructose, galactose• Dissaccharides – double sugars
sucrose, lactose, maltose• Polysaccharides – complex forms
starch, glycogen, cellulose (fiber)• Recommended intake: 60% of total Kcal (300g)
Fiber 25-30g daily
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Carbohydrates
• What are some other functions of carbohydrates in our bodies?
Laxative effects of:
LactoseCellulose
DIETARY FIBER - Helps regulate blood sugar
May reduce risk of hyperlipidemia
May reduce risk of some cancers
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Protein• Proteins: composed of amino acids
• Digested by enzymes (proteolytic)
• Absorbed in small intestine
• Metabolism includes:
• Anabolism=Catabolism: Nitrogen balance
• Function: maintain body tissue and tissue growth
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Protein (CHON)• Carbon-Hydrogen-Oxygen- Nitrogen• 1 gram of protein = 4 Kcal• Comprised of 22 amino acids which can be comined by
body to form over 1000 types of proteins• 9 essential amino acids – body cannot synthesize them• Complete protein = one with all 9 essential amino acids
(animal sources and soy)• Incomplete proteins = contain some but not all essential
(plant sources)• Complementary proteins = 2 proteins that when
combined provide all essential amino acids.• Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)
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Proteins (CHON)
• What are some other functions of proteins?
Fluid Balance
Ex: Albumin
Energy ( last resort)De-amination / Nitrogen stripped from CHON to create glucose CHO
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Lipids• Lipids: insoluble in water• Digested by enzymes (lipase,bile) in
stomach and small intestine• Absorbed in small intestine• Metabolism includes conversion (by
liver and small intestine) into soluble compounds called lipoproteins
• Function: energy, insulates body, absorption (fat-soluble vitamins)
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Lipids (Fats)• Carbon-Hydrogen-Oxygen• 1 gram of Fat = 9 Kcal• Composed of fatty acids: (linoleic&linolenic =essential)
• Saturated fat = mostly animal source• Unsaturated fat = mostly plant and fish sources• Triglyceride = fat in bloodstream /storage form of fat
in body. • Trans Fat = hydrogenated fats in processed foods• Recommended intake: 20-35% of total Kcal
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Lipids• Lipoproteins - made by the body to move water-
insoluble lipids (such as cholesterol) thru the bloodstream
• LDL (low density lipoprotein)- major carrier of cholesterol. Function is to transport cholesterol from liver into circulation. “Bad cholesterol”
• HDL (High density lipoprotein) - carries cholesterol away from tissue to liver ..high levels decrease atherosclerosis. “Good cholesterol”
• Cholesterol- not essential from diet as the body produces enough.
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Desirable Blood Lipid Levels
• Total Cholesterol < 200• Triglycerides < 150• LDL < 100• HDL > 40 Male
> 50 Female• Elevated Blood Lipid Levels
(Hyperlipidemia) = increased risk for CHD, Hypertension, Stroke, MI
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Vitamins• Vitamins: required in small amounts
• water- soluble: absorbed through intestine directly into blood stream (C, B complex folic acid)
• fat-soluble: absorbed with lipids into lymphatic circulation (A,D,E,K)
• Function: needed for metabolism of carbohydrates, lipids & proteins
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Water-soluble vitamins text review
Vitamin C (ascorbic acid)
• Function: collagen formation (wound
healing), antioxidant, immune system
• More prone to deficiency; not stored
• Deficiency: bleeding gums, scurvy, poor wound healing
• Source: citrus fruits, tomatoes, broccoli
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Vitamin B Complex : thiamine, riboflavin, niacin, B6, B12
• Function: metabolism of carbs, lipids and proteins
• RNA, DNA synthesis (folic acid) & heme formation (B12)
• Deficiency:beriberi, poor wound healing, anemia, pernicious anemia
• Sources: Whole grains Organ meats
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Vitamin B12 (continued)
Vitamin B12 (cobalamine)• Important for hemoglobin synthesis• Very little found in vegetable sources (unlike other B Vitamins)
• Pernicious anemia = B12 deficiency or lack of intrinsic factor for B12 absorption.Susceptible population = Total VeganClients w/ decreased gastric acid secretion(gastric bypass, stomach cancer)
• Rx = B12 injections
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Folic Acid
Folic Acid (Folate)
• Folic Acid Deficiency leads to elevated Homocysteine levels which are associated with increased risk for CHD.
• Folic Acid Deficiency linked to neural tube defects – Spina Bifida
• Natural folate (in foods) only ½ as available to body as supplement folic acid
• 1998 = mandatory fortification of breads/grains• Supplements recommended for: women of child-bearing
age, gastric surgery, malabsorption (alcholic)
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Fat-soluble Vitamins text review• Vitamin A: function- visual acuity, skin maintenance…
deficiency-night blindnessDark green leafy vegs, yellow/orange vegs
• Vitamin D: function-calcium absorption… deficiency-rickets, bone malformationFortified milk, ultraviolet light
• Vitamin E: function-antioxidant, heme synthesis…deficiency-RBC hemolysisWhole grains, nuts
• Vitamin K: function-formation blood clotting proteins…deficiency- hemorrhageDark green leafy vegs, synthesized by bacteria in sm intestine
• More prone to toxicity; stored by body
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Minerals• Minerals: macrominerals or microminerals
• Originate in earth’s crust, aren’t digested or metabolized. Combine to form salts or organic compounds. Always retain their chemical properties.
• Function: provide structure within the body (bones/teeth, F/E and acid /base balance, nerve transmission, muscle contraction)
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Macrominerals text review
• Calcium: bone/ teeth formation, blood clotting, nerve transmission…deficiency-tetany, osteoporosis
• Phosphorous: bones, acid-base balance…deficiency- muscle weakness
• Magnesium: bones, metabolism ...deficiency-muscle pain, poor cardiac function
• Potassium: f/e balance, acid-base balance…
deficiency-muscle cramps , irregular ht. rate
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Microminerals text review
• Iron: hemoglobin formation…deficiency-anemia
• Iodine: thyroid hormones…deficiency- goiter
• Zinc: wound healing … deficiency-impaired immune system
• Fluoride: teeth/bones…deficiency- discolored tooth enamel
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Energy Balance• Kilocalorie- unit of heat; measures the
energy in the diet• Basal metabolic rate (BMR)- amount
of energy needed for all the biochemical processes to occur when the body is at rest.
• Proper nutrition provides the energy needed to maintain health
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Body Weight Standards• Ideal body
weight IBW = balance of energy used by the body and intake of nutrients
• Rule of thumbWomen: 100 lbs lst 5ft
5 lbs/inch over 5ftMen: 106 lbs lst 5 ft 6 lbs/inch over 5ft
• Standardized chartsOverweight = 10% > chartObese = 20% > chart
• Body mass index(BMI) 18.5 – 24.9 healthy> 25 = overweight> 30 = obese> 40 = morbidly obese
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Calculate your BMI
Weight (lbs)
Height (inches) squared
X 705
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Factors Affecting Nutrition• Developmental• Gender• Ethnicity &
culture• Food beliefs• Preference• Religion
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Factors Affecting Nutrition• Lifestyle• Medications &
therapy• Heath status• Advertising• Alcohol
Consumption• Psychological
factors
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Adequate Nutrition• Food Guide
Pyramid
• Daily reference intake
• Food Labeling
• Dietary guidelines
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Dietary Guidelines
• Balance / Moderation / Variety
• Maintain healthy weight
• Exercise
• Eat a variety of foods in moderation
• Low sodium / Low fat / Low simple sugars
• Alcohol in moderation
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Assessing: Nutrition• Nursing history • Physical exam• 24-hr. recall• Food records• Anthropometic data• Lab tests – Albumin & Prealbumin
Hemoglobin Transferrin
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Nursing Dx• Imbalanced nutrition: less than body
requirements R/T NPO status AEB height 5’6’’ wt 105 lbs., pt. states “ I’ve never been this skinny before, my clothes are hanging off of me”
• Impaired dentition R/T nutritional deficits AEB dentures not fitting properly
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Planning- outcome criteria• Pt. will:
• Attain and maintain ideal body weight
• Eat a variety of foods at each meal
• Promote healthy nutritional practices
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Interventions
• Monitoring food intake
• Assist with feeding
• Stimulate appetite• Teaching
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Diet Restrictions• NPO• Clear liquids-see
through (broth, apple juice)
• Full liquids –foods that turn to liquid at room temp. (shakes, milk)
• Soft –easily chewed and digested
• Low residue- no seeds, raw vegetables or fruits, whole grains
• High fiber- raw fruits, grains, vegetables
• Sodium restricted:– Mild 2 gram Na/day– Moderate 1gram– Strict 500mg– Severe 250 mg– DASH Dietary Approaches
to Stop Hypertension
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Diet Restrictions
• Calorie restrictions
• Diabetic diet
• Cholesterol
• Food textures:Thick it
• Thin
• Nectar-like
• Honey-like
• Spoon-thick
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Enteral Nutrition
• Used when oral intake is inadequate, swallowing difficulty, coma
• Tube passed into gastrointestinal tract to deliver nutrients
• Maintains GI integrity preferred over parental feedings (via veins)
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Enteral Nutrition
• Short term use
• Nasogastric
• Nasointestinal
• Long term use
• Gastrostomy• Percutaneous
endoscopic gastrostromy (PEG)
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Enteral Formulas
• Many types of formulas
• Administered continuous or intermittent
• Use pumps to monitor intake
• Monitor Intake & Output
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Enteral Precautions
• Prevent aspiration– Position fowlers/high fowlers
– Assess placement…check pH
– Note residual
– Auscultate bowel sounds
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Enteral Precautions
• Preventing complications include:
• Clogged tube• Nasal erosion• Diarrhea• Infection• Dislodgement
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Parental Nutrition
• Bypasses GI tract, nutrition administered IV, more complicated
• Total parental nutrition (TPN) also called (hyperalimentation)…central line
• Partial parental nutrition (PPN)..PICC line
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Evaluation
• Use established outcomes to evaluate the pt’s response to care
• Pt understanding of therapeutic diet
• Reassess S&S associated with altered nutrition (wt, intake, lab results)
• Determine pt’s satisfaction with nutritional therapy
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Summary• Nurses role, to understand nutrients and
how they affect nutrition• Various factors affect one’s nutritional
status• Interventions include numerous diets,
assisting with feeding, monitoring and teaching
• Nutrition can also be administered enterally or parentally