Nutrition Fundamentals NURS 230/Spring 2013

Scientific Knowledge Base: Nutrients Carbohydrates Starches and sugars Proteins Amino acids Fats Saturated, monounsaturated, and polyunsaturated Water Cells depend on a fluid environment Vitamins Essential to metabolism Water or fat soluble Minerals Catalysts for biochemical reactions

Anatomy and Physiology of the Digestive System Digestion Begins in the mouth and ends in the small and large intestine Absorption Intestine is the primary site for absorption Metabolism and Storage of Nutrients Anabolic and catabolic reactions Elimination Chyme is moved through peristalsis into the large intestines and turned into feces

Dietary Guidelines Dietary reference intakes –Acceptable range of amounts of vitamins and minerals to avoid deficiencies for age and gender groups Food guidelines –Food Pyramid Guide, basic guide for meal preparations Daily values –Needed protein, vitamins, minerals, fats, cholesterol, carbohydrates, fiber, sodium, and potassium

Nursing Knowledge Base: Nutrition During Human Growth and Development Infants through school age Adolescents Young and middle adults Older adults

Older Adult Poor food intake/ Poor appetite Lack of financial resources Not able to prepare or eat balance meal Anxiety Difficulty chewing/ swallowing

Older Adult Multiple medications Constipation Food preferences Religious Beliefs Depression Disease condition Loss of independence

Goals of Nutrition for the Elderly Maintenance of health Promotion of quality of life Great meal is very important to the Elderly!!!

Diet Modification Therapeutic/Nutrient Modification Texture/ Consistency Modification NAS, NCS, Low Fat, Low Cholesterol, Bland, Renal diet, 2gNa, 3gNa, Vegetarian, 1500Cal, 1800 Cal, 2000Cal, Low potassium, Fortified diet, small and large portion Mechanical Soft, Pureed, Ground meat, cut up meat, dental soft, nectar thickened, honey thickened, pudding consistency, dysphagia diet

Regular Diet  No diet modification or restriction  Salt is allowed, provided with salt packets in tray  Food may be prepared in different ways of cooking  May have regular sugar, creamer and other condiment  Served with regular liquids  Regular dessert

Therapeutic/ Nutrient Modification  No added Salt (4gNa) - regular diet, no salt packets, may have Mrs. Dash  Low Salt (3gNa) - regular diet, high salted foods are omitted like ham, pastrami, corned beef - no salt packets, may have Mrs. Dash  2gNa - avoid regular muffin, biscuits, sweet rolls, doughnut - no salt packets, may have Mrs. Dash - unsalted margarine, crackers, gravies and sauces

Therapeutic/Nutrient Modification  Diabetic Diet/ Low/ No Concentrated Sweets, ADA diet (ex. 1500Cal, 1800Cal etc) - regular diet is served, concentrated sweets are omitted (ex. Sugar packets, most foods containing sugar) - follow the portion/serving size in the therapeutic spreadsheet ADA cookies are not the only dessert allowed!!!

Therapeutic/Nutrient Modification  Renal Diet -Increase protein, low salt, low potassium, low phosphorus -Follow the spreadsheet/ recipe and the tray card for diet modification  Low Fat/ Low Cholesterol - Low cholesterol egg - High fat entrees are substituted by low fat low cholesterol entrees -Follow the therapeutic spreadsheet/ recipe for diet modification

Therapeutic/Nutrient Modification  Fortified Diet - Breakfast Cereal topper, Milk - Lunch/ Dinner Margarine, ice cream, pudding, milk, gravy - follow modifications as per tray card  Vegetarian Diet - follow vegetarian modification in the recipe

Therapeutic/ Nutrient Modification  Bland diet - individualized - foods frequently omitted coffee, soda, coca beverages, chili powder, spicy foods, black pepper, alcohol

Texture/ Consistency Modification  Mechanical Soft - most foods are softened, cut up, diced, chopped or minced. Some raw foods are omitted. -designed for residents with chewing problems.  Pureed - regular or therapeutic diet is pureed - designed for residents with chewing and swallowing problems

Texture/ Consistency Modification  Nectar thickened, Honey thickened and Pudding thickened - gelatin and ice cream are not allowed - do not leave thin water at bed side

Parenteral Nutrition Administered to clients who are unable to digest or absorb enteral nutrition Peripheral or through a central line Initiating parenteral nutrition Preventing complications

Enteral Tube Feeding Nasogastric Nasointestinal Gastrostomy Jejunostomy PEG PEJ

Parenteral Nutrition Administered to clients who are unable to digest or absorb enteral nutrition Peripheral or through a central line Initiating parenteral nutrition Preventing complications

Assessment Screening Anthropometry Laboratory and biochemical tests Dietary and health history Physical examination

Nursing Diagnosis Risk for aspirationDiarrhea Deficient knowledge Readiness for enhanced nutrition Feeding self- care deficit Impaired swallowing Imbalanced nutrition: more than body requirements Imbalanced nutrition: less than body requirements Risk for imbalanced nutrition: more than body requirements

Implementation Advancing diets Promoting appetite Assisting with oral feedings

Summary  Meals are the highlight of the day for the resident  Food presentation and serving food at proper temperature is very important  We serve food for maintenance of health and promote quality of life  Follow diet, serving portion, therapeutic spreadsheet, recipe, adaptive feeding device  If meal substitution cannot be avoided then appropriate food substitute

QUESTIONS ????