Chapter 44

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Nutrition

Elements of Energy and Nutrition

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Basal metabolic rate (BMR)Resting energy expenditure (REE)Nutrient densityNutrients: carbohydrates, proteins, fats,

water, vitamins, minerals

Carbohydrates

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Produce 4 kcal/gMain source of energySaccharides: simple and complex

carbohydrates, fiber

Proteins

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Produce 4 kcal/gEssential for growth, maintenance, and

repair of body tissueAmino acids: essential and nonessentialComplete and complementary proteinsNitrogen balance

Fats (Lipids)

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Produce 9 kcal/gTriglycerides and fatty acidsSaturated or unsaturated:

monounsaturated or polyunsaturated fatty acids

Essential or nonessential fatty acids

Water

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Comprises 60% to 70% of body weightCell function depends on a fluid

environment

Vitamins

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Essential to normal metabolismFat-soluble: A, D, E, KWater-soluble: C and B complex

Minerals

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Inorganic elements essential as catalysts in biochemical reactions

MacromineralsMicrominerals or trace elements

Digestive System

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Anatomy and physiologyDigestionAbsorptionMetabolism and storage of nutrientsElimination

Dietary Guidelines

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Dietary referenced intakes (DRI’s)Recommended range of intakeFood guidelines: food guide pyramidDaily valuesHealthy People 2010 focus areaSpecific diets: diabetic, gluten-free,

culturally specific

Nutritional Needs throughout Growth and Development

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Infants through school-ageBreast-feedingFormulasSolid foodsFood habits

AdolescentsEating disordersActivities

Nutritional Needs throughout Growth and Development (cont'd)

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Young and middle adultsPregnancyLactation

Older adultsLess efficient systems

Constipation, decreased absorption of nutrientsAltered [diminished] sense of tasteChewing/swallowing problems

Alternative Food Patterns

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Cultural and religious practicesVegetarian diets

Assessment: Diet History

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Dietary intake and patternSymptomsAllergiesTasteChewing and swallowingAppetiteEliminationMedications

Assessment

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Anthropometry [Ht, Wt, measurement, BSA]

Body mass index (BMI)Ideal body weight (IBW)Laboratory testsClinical observationsClient expectations

Nursing Diagnoses

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Risk for aspirationAlteration in fluid/electrolyte balanceImbalanced nutrition: less than/more

than body requirementsSelf-care deficit: Feeding Knowledge deficit

Planning

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Goals and outcomesClient’s daily nutritional intake will meet

his needs AEB…Client will lose ½ pound per week until…Pt will choose foods that meet his

nutritional needs /fit within dietary guidelines

Education/ pt teachingContinuity of care – written plan

Implementation: Health Promotion

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Client educationMeal planningFood storage and preparation safety

Implementation: Acute Care

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Advancing dietsPromoting appetiteAssisting clients with feedingEnteral feeding

Can’t ingest, can digest/eliminateParenteral nutrition

Can’t ingest/digest/eliminate [any or all]

Enteral Feeding

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Nasogastric, jejunal, gastric tubesInsertion and verification of placement

X-ray best; 2 other methods if no X-rayTypes and preparation of formulas

Complete or elemental, cal/ml orderedComplications

Aspiration, occlusion, imbalances

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Parenteral Nutrition

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Initiation and management of insertion site [surgical asepsis]PIV, PICC

Types of solutionsDextrose, TPN, Lipids

Rate of infusion – use pumpPrevention of complications

Emboli, sepsis, occlusion

Implementation: Restorative Care

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Medical nutrition therapy for specific illnesses, conditions, or injuriesGI diseases [avoid irritants, eat often]Diabetes [carbs, limit fat, individualize]Cardiovascular diseases [limit salt, fat]Cancer [hi nutrient, flavor, digestibility]HIV [max nutrition, calories]

Evaluation

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Short term: did pt. choose foods…...eat breakfast… go to DR

Long term: did pt. gain/lose wt?Revise goals as neededTeach pt/caregiver & involve to promote

independence and healthPass info to next setting [LTC]

Questions?

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