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Transcript of Chapter 35 Nutrition. 35-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc....
![Page 1: Chapter 35 Nutrition. 35-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition Nutrition is the process.](https://reader036.fdocuments.us/reader036/viewer/2022062306/5a4d1b397f8b9ab05999df7c/html5/thumbnails/1.jpg)
Chapter 35
Nutrition
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35-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiology of Nutrition
Nutrition is the process by which the body metabolizes and utilizes the nutrients from food.
Nutrients are digested, absorbed by the blood or lymphatic system, and transported to the body’s cells.
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35-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiology of Nutrition
Digestion is the process by which ingested foods are broken down in the GI tract to smaller segments in preparation for absorption.
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35-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiology of Nutrition
Absorption is the process by which the end products of digestion pass through the epithelial membranes in the small and large intestines into the blood or lymph systems.
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35-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiology of Nutrition
The end products of digestion are monosaccharides (simple sugars), amino acids, glycerol, fatty acid chains, vitamins, minerals, and water.
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35-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiology of Nutrition
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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35-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiology of Nutrition
Metabolic rate refers to the rate of heat liberation during chemical reactions.
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35-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Metabolism
Energy• A calorie is the unit of measurement used to
express the quantity of energy released during metabolism.
• Energy is expressed in terms of kilocalories.• Basal metabolic rate (BMR) represents the
energy needed to maintain essential physiological functions.
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35-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Metabolism
Excretion• Digestive and metabolic waste products are
excreted through the intestines and rectum.• Other excretory organs are the kidneys,
sweat glands, skin, and lungs.
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35-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Water Vitamins Minerals Carbohydrates Proteins Lipids
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35-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Water• 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.• Body water requirements are met through
consumption of liquids and foods and the oxidation of food.
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35-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Vitamins• Organic compounds that aid in the
regulation of cellular metabolism and assist in the biochemical processes that release energy from digest food
• Vitamins are classified as fat-soluble or water-soluble.
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35-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Minerals• Serve as catalysts in biochemical reactions.• Classified according to daily requirement:
- Macrominerals (quantities of 100mg or greater)- Microminerals (trace elements, quantities less
than 100 mg)
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35-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Carbohydrates• Organic compounds composed of carbon,
hydrogen, and oxygen• Primary source of energy for the brain and
the preferred fuel for the body
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35-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Carbohydrates• 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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35-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Proteins• Organic compounds that contain carbon,
hydrogen, oxygen, and nitrogen atoms• Essential for almost every bodily function
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35-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
The end products of protein 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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35-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
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 acid.
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35-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Protein Deamination is the process of removal of (degradation) amino groups from the amino acids.
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35-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Other physiological processes occur during protein deamination.• Gluconeogenesis• Ketogenesis• Nitrogen balance• Positive nitrogen balance• Negative nitrogen balance• Obligatory loss of proteins
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35-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Lipids (fats) • Organic compounds are the only essential
nutrients that cannot mix with water and therefore, must be emulsified by molecules to be absorbed.
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35-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Fatty Acids • Simplest form of lipids and the basic components of
more complex lipids• Saturated fatty acids form fats, which are 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.
Monounsaturated Fatty Acids Polyunsaturated Fatty Acids
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35-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Fatty Acids• Monounsaturated fatty acids are formed
esters with one double or triple bond.• Polyunsaturated fatty acids form esters that
have many carbons unbonded to hydrogen atoms.
• Hydrogenated or trans-fatty acids are another category of fat that is not naturally occurring but man made.
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35-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nutrients
Most Important Lipids• Triglycerides are 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; they usually contain a nitrogenous base.
• Cholesterol is produced by the body and is considered a fat; it is also found in whole milk and egg yolk.
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35-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Promoting Proper Nutrition
Recommended Daily Allowances (RDAs) The Food Guide Pyramid outlines six
groups of food and the number of servings based on dietary guidelines and the basic four food groups.
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35-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Promoting Proper Nutrition
Societal Concerns• One-third of the U.S. population is
considered overweight.• Obesity is becoming an epidemic.• Undernutrition is a specific problem for the
elderly and for people with eating disorders.
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35-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Weight Management
Overweight is an energy imbalance in which more food is consumed than needed.
An underweight person expends more calories than are consumed.
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35-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Weight Management
Anorexia nervosa (self-starvation) disrupts metabolism because of inadequate calorie intake.
Bulimia nervosa refers to food-gorging binges followed by purging of food, usually through self-induced vomiting or laxative abuse.
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35-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Affecting Nutrition
Age Lifestyle Ethnicity, Culture, and Religious
Practices Economics Gender
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35-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Assessment
Nutritional History• 24-hour recall• Food-frequency questionnaire• Food record• Diet history
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35-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Assessment
Physical Examination• Intake and Output (I & O)• Anthropometric Measurements
- Skinfold measurements- Mid-upper-arm circumference- Abdominal-girth measurement
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35-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Assessment
Measuring the mid-upper-arm circumference
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35-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Diagnostic and Laboratory Data
Protein Indices Serum Albumin Pre-albumin Serum Transferrin
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35-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Diagnostic and Laboratory Data
Hemoglobin Level Total Lymphocyte Count Nitrogen Balance Urine Creatinine Excretion
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35-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Diagnoses
Imbalanced Nutrition: Less Than Body Requirements
Imbalanced Nutrition: More Than Body Requirements or Risk for More Than Body Requirements
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35-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Other Nursing Diagnoses
Activity Intolerance Acute Pain Ineffective Health Maintenance High Risk for Impaired Skin Integrity Constipation Impaired Swallowing
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35-37Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Outcome Identification and Planning
Expected outcomes are formulated to promote optimal nutritional care.
In the planning phase, the nurse identifies dietary needs and explains the need for and basis of therapy.
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35-38Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Monitoring Weight and Intake Diet Therapy
• Nothing by Mouth (NPO)• Clear-Liquid • Liquid • Soft • Mechanical Soft • Pureed
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35-39Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Diet Therapy• Low-residue • High-fiber • Liberal bland • Fat-controlled • Sodium-restricted • Lactose intolerance
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35-40Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Assistance with Feeding Providing Nutrition Support Nutrition Support Teams
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35-41Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Providing Enteral Nutrition• Feeding tubes• Insertion of enteral feeding tubes• Enteral formulas
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35-42Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Enteral Feeding Routes
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35-43Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Administration of Enteral Feedings• Safety considerations• Potential complications• Removal of a nasogastric tube
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35-44Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Providing Parenteral Nutrition (PN)• Intravenous infusion of a solution directly
into a vein to meet the client’s daily nutritional requirements
• Used to treat malnourished clients or clients who have the potential for becoming malnourished and who are not candidates for enteral support.
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35-45Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Components of Parenteral Nutrition• Carbohydrates found primarily in form of
dextrose• Amino acids• Lipids (fat emulsions)
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35-46Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Administering Medication through a Feeding Tube• Types of feeding tubes• Checking for tube placement• Clearing the tubing of formula• Checking the patency of tube• Flushing the port• Measuring intake and output
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35-47Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Complementary Therapy• Nutrition is integrated as part of the
therapeutic regimen of numerous types of complementary therapies.
• Diet and nutrition are used by many alternative modalities for the prevention and treatment of chronic diseases.
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35-48Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Evaluation
Current data is used to measure achievement of goals and outcomes.
The plan of care is modified to maximize the client’s response to therapy.