Nutrition

Principles of Nutrition

1. Digestion – process by which food substances are changed into forms that can be absorbed through cell
membranes
2. Absorption – the taking in of substance by cells or membranes
3. Metabolism – sum of all physical and chemical processes by which a living organism is formed and
maintained and by which energy is made available
4. Storage – some nutrients are stored when not used to provide energy; e.g. carbohydrates are stored either
as glycogen or as fat
5. Elimination – process of discarding unnecessary substances through evaporation, excretion

Nutrients
1. Carbohydrates – the primary sources are plant foods

Types of Carbohydrates
 a. Simple (sugars) such as glucose, Galactose, and fructose
b. Complex such as starches (which are polysaccharides) and fibers (supplies bulk or roughage to
the diet)

2. Proteins – organic substances made up of amino acids

3. Lipids – organic substances that are insoluble in water but soluble in alcohol and ether.
a. Fatty acids – the basic structural units of all lipids and are either saturated (all the carbon atoms
are filled with hydrogen) or unsaturated (could accommodate more hydrogen than it presently
contains)
b. Food sources of lipids are animal products (milk, egg yolks and meat) and plants and plant
products (seeds, nuts, oils)

4. Vitamins – organic compounds not manufactured in the body and needed in small quantities to
catalyze metabolic processes.
a. Water-soluble vitamins include C and B-complex vitamins
b. Fat-soluble vitamins include A, D, E, and K and these can be stored in limited amounts in the
body
5. Minerals – compounds that work with other nutrients in maintaining structure and function of the body
a. Macronutrients – calcium, phosphate, sodium, potassium, chloride, magnesium and sulfur
b. Micronutrients (trace elements) – iron, iodine, copper, zinc, manganese and fluoride The best
sources are vegetables, legumes, milk and some meat
6. Water – the body’s most basic nutrient need; it serves as a medium for metabolic reactions within
cells and a transporter from nutrients, waste products and other substances

 Nutrition: the study of how food nourishes the body. Includes the study of nutrients and how they are
handled by the body as well as the impact of human behavior and
Environment on the process of nourishment. Involves physiology, psychology, and
Socioeconomics.

 Nutrients: Specific biochemical substances used by the body for growth, development, activity,
reproduction, lactation, health maintenance, and recovery from illness or injury.

 Nutrients need to change throughout the life cycle in response to changes in body size, activity, growth,
development, and state of health.

 Essential nutrients: nutrients that are not synthesized in the body or are made in
Insouciant amounts.

They must be provided in the diet or through supplements.

 Macronutrients: Nutrients that supply energy and build tissue

 Carbohydrates : Primary sources are plant foods.
 Simple Carbs (sugars): Glucose, Galactose, and Fructose (all are water soluble)
 Complex Carbs: Starches (Polysaccharides) and fibers (supply bulk or roughage to diet)
 Digestion: Carbs are absorbed in small intestine; insulin augments glucose transport through cell
membrane of body cells.
 o Water: (Doesn’t provide energy, needed to regulate body processes): Serves as a medium, for
metabolic reactions within cells and transports nutrients, waste products, and other substances.

o Protein: Organic substances made up of amino acids; complete proteins are found in animal products
such as eggs, milk, and meat; incomplete proteins are found in legumes, nuts grains, cereals, and
vegetables.

o Fats (Lipids): Organic substances that are insoluble in water but soluble in alcohol and ether.
 Food sources for lipids are animal products (milk, egg yolks, and meats) and plant and plant
products (seeds, nuts, oils).o Minerals and vitamins required in hundreds of grams

o Minerals and vitamins required in hundreds of grams

 Micronutrients: Required in much smaller amounts to regulate and control body processes

o Minerals: Compounds that work with other nutrients in maintaining structure and function of body
 Macro minerals: Calcium, phosphorus, sodium, potassium, chloride, magnesium, and sulfur.
 Micro minerals: Iron, iodine, copper, zinc, manganese, and chloride
 Necessary for health.
 Best sources: vegetables, legumes, milk, and some meats
 Required in milligrams or micrograms

Nonessential Nutrients: Do not have to be supplied through dietary sources because they either are not
required for body functioning or are synthesized in the body in adequate amounts.
 Nutrients can be converted to others in the body.
Ex. Excess carbohydrates and protein into fat and stores them as triglycerides.
 Energy in the diet is measured in the form of kilocalories (calories).
o Only carbohydrates, protein, and fat provide energy.
o Vitamins and minerals are needed for the metabolism of energy, do not provide calories.
 Basal Metabolism: the energy required to carry on the involuntary activities of the body at rest.
Body Mass Index (BMI): Correlates weight with height using a monogram or chart

o Considered to be more reliable indicator by health professionals (from PPT)

o A ratio of weight (in kilograms) to height (in meters).

 Underweight: below 18.5

 Overweight individual: 25-29.9
 Obesity: 30
 extreme obesity: 40
Basal Metabolic Rate (BMR): The rate at which the body uses energy while at rest to keep vital functions
going, such as breathing and keeping warm.
 Males have a higher BMR due to larger muscle mass
o BMR is about 1 Cal/kg of body weight per hour for men
o BMR is about 0.9 Cal/kg of body weight per hour for women

 Factors that increase BMR

o Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated
levels of certain hormones
  Factors that decrease BMR
o Aging, prolonged fasting, and sleep
o Ideal body weight (IBW): optimal weight recommended for optimal health o Ideal weight
based on height

 Factors Influencing Nutrition

 Developmental considerations
o Growth: infancy, adolescence. Pregnancy, and lactation increase nutritional needs
o Activity increases nutritional needs.
o Age-Related changes in metabolism and body composition
o Nutritional needs level of in adulthood
 Fewer calories required in adulthood because of decrease in BMR
 Nutritional Assessment
o Diet History
 Dietary (usual eating paKerns and habits, frequency, types of foods)
 Medical (Health factors that May affect nutrition)
 Socioeconomic (Is client suffering from economic hardship?)
o Physical Assessments
 Focus on skin, hair nails, eyes, and mucosa
 Find evidence w/ lab tests & dietary data
 Serum Proteins (pre albumin, albumin, total protein)
 Serum albumin levels (3.5-5g): Help identify chronic nutrition problems, also can tell a patient’s
hydration status (Over hydration= low albumin, Dehydration= Very high level; Low level:
Malnutrition[prolonged protein depletion], malabsorption)
 Pre albumin Levels (23–43 mg/dL): Indicate short term nutritional status and can be used to detect
daily changes in a patient’s protein status. (Low level: protein depletion, malnutrition)
 Hemoglobin & Hematocrit
 Hemoglobin (12-18 g/dL): Decreased = Iron deficiency anemia
 Hematocrit (40%-50%): Decreased= iron deficiencies, under nutrition; increased= dehydration
 Blood Urea Nitrogen [BUN] & Creatinine
 Blood Urea Nitrogen [BUN] (5-25 mg/dL): Elevated levels: starvation, high protein intake, severe
dehydration; low levels: malnutrition, over hydration
 Creatinine (0.4-1.5 mg/dL): High levels: dehydration; Low levels: Skeletal muscles atrophy bc of
severe malnutrition
 Focused assessment guide (nutritional status factors
o Usual dietary intake (does your current intake differ from your usual intake?)
o Food allergies or intolerances
o Food preparation and storage (who does food shopping, preparation of meals, how?[fried,
baked, broiled], do you have adequate food storage space)
o Eating disorder paKerns

 Malnutrition: lack of proper nutrition

 Over nutrition: Malnutrition in which nutrients are over supplied relative to the amounts required for
normal growth, development, and metabolism. Can lead to: overweight, or obesity
 Under nutrition: Outcome of insufficient food intake and repeated infectious diseases, can lead to
deficiency in vitamins and minerals, being underweight for one’s age, short for one’s age, or
dangerously thin for one’s height.
o Protein Calorie Malnutrition (PCM): inadequate protein intake.
 Nursing interventions
o Screen patient at home for nutritional risk
o Observing intake and appetite
o Evaluate patient tolerance
o Assist patient w/eating
o Consulting w/dietitian & physician
o Addressing potential for drug-nutrient reactions
o Obtaining more food or snacks for patient if appropriate
o Monitoring food brought in by visitors
o Participating in nutrition education effort’s
 Liquids that are included: Gelatin, fat free broth, ice pops carbonated beverages
 Nutrients that are missing? Calories, protein, and most nutrients
 Full Liquid Diet : Liquids or foods that turn liquid @ body temp
 Liquids or foods that are included: Milk, pudding, custard, frozen desserts eggs, cereal
gruels, veggie juice,
 Nutrients are missing: High-protein is recommended if full diet longer than 3 days
 Cardiac patient : Low fat low sodium
 Fruit helps increase fiber and cure sweet craving
 Renal Patient : Low protein, high carbohydrate, low sodium and potassium
 Controlled fluid intake
 Ideal nutrition: Foods from all varieties
 Low sodium diet: No ketchup, no soy sauce, no salad dressing; Yes: oil, vinegar, ginger, thyme,
anything NATURAL
 Iron deficiency: Eat lots of green
 Soft Diets : (soft, mechanical soft, and pureed)
 Low residue (Low-Fiber)
 Vegetarians: at risk for protein, iron, calcium, zinc, & vitamin B12 deficiency.

Enteral Feedings
o Nasogastric Tube (NGT)- short term
o Percutaneous Endoscopic Gastronomy (PEG)- long term
 Keep patient at 45 degree angle
o Testing Feeding Tube Placemen
 From tip of nose to ear and then down chest
 Check with X-ray
o To verify placement before feedings and at intervals
 Aspirate GI secretions
 Measure pH of aspirated fluid
 Auscultate epigastrium while injecting 5-20 mL of air
 Confirm length of tube insertion with insertion mark
o Complications
 Aspiration
 Clogged tube
  Skin irritation/erosion
 GI upset
o Administer
 Intermittent – 300 – 500 mL per feeding over 30 minute period; usually administered
room temp
 Continuous – administered over 24 hours with infusion pump; usually administered room
temp
 Refer to Skill 36-2
Must do chest x-ray to check that tube is in correct place.
When administering, start off slow, 20-25 cc/hrs., do not fill bag all the way because it can create bacteria
making patient sick.
Must aspirate tube to check residual volume. Whatever comes out must go back in
o If taking too long to digest, slow down rate of administration
o If continues to happen call DR. and ask opinion.
o Stop tube feeding on anything over 100

If abdominal pain stop feeding

 Parenteral Nutrition
 Total parenteral nutrition (TPN) or IV hyper alimentation
o Hypertonic, injected only into large veins (subclavian/ femoral)
o Used in clients with severe malnutrition, severe burns, bowel disease disorders, acute renal
failure, hepatic failure, metastatic cancer, major surgeries (NPO 5 days)
o Sterile – change tubing every 4 hours. Check glucose every 6hrs.
o Risk of infection and fluid/electrolyte imbalances because of high sugar content• Requires
sterile technique, frequent lab monitoring for TPN modification
o Continually check Blood Glucose because of high sugar content
o Infusions started gradually to prevent hyperglycemia; glucose levels monitored
o Discontinued gradually to prevent hyper insulinemia and hypoglycemia
o Peripheral Parenteral Nutrition (PPN): Less concentrated solution, can provide lipids
but associated with phlebitis(infiltration of the walls of the vein and usually the formation
of a clot in the vein) Used more to prevent than to correct nutritional imbalance
 Safety as it comes to enteral feeding
o Placed properly
o Head is elevated
o Not lying flat
 Intermittent feedings – when feeding has stopped and you are about to start it again Patency.