Focus on Nutrition (Relates to Chapter 40, “Nursing Management: Nutritional Problems,” in the textbook) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Normal Nutrition Process in which the body uses food for energy, growth, and maintenance and repair of tissuesProcess in which the body uses food for energy, growth, and maintenance and repair of tissues USDA—MyPyramid with guidelines for healthy dietUSDA—MyPyramid with guidelines for healthy diet Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

3 Normal Nutrition Essential components of basic food groupsEssential components of basic food groups  Carbohydrates  Fats  Proteins  Vitamins  Minerals Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

4 Food Pyramid Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig In the MyPyramid, each food group is characterized by varying widths, representative of the proportion of each group that should be eaten. The person climbing the stairs on the side of the pyramid indicates the need to include daily physical activity in a healthy lifestyle.

5 Normal Nutrition CarbohydratesCarbohydrates  Are primary source of energy 4 kcal/gram  Chief protein-sparing ingredient  Compose 45% to 65% of daily caloric needs  Simple versus complex Monosaccharides (simple) Disaccharides (simple) Polysaccharides (complex) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

6 Normal Nutrition Monosaccharides (simple)Monosaccharides (simple)  Glucose  Fructose  Found in fruits and honey Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

7 Normal Nutrition Disaccharides (simple)Disaccharides (simple)  Sucrose  Maltose  Lactose  Glucose  Fructose  Found in table sugar, malted cereal, milk Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

8 Normal Nutrition Complex carbohydrates (polysaccharides)Complex carbohydrates (polysaccharides)  Starches such as cereal grains, potatoes, and legumes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

9 Normal Nutrition FatsFats  Major source of energy  Source of insulation  Carriers of essential fatty acids and fat- soluble vitamins  20% to 35% of total daily caloric intake  9 kcal/gram Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10 Normal Nutrition ProteinsProteins  Essential for tissue growth, repair, and maintenance  Body regulatory functions  Energy production Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Normal Nutrition ProteinsProteins  Complex nitrogenous organic compounds consisting of amino acids  Obtained from animal and plant sources  4 kcal/gram  10% to 35% of daily caloric needs  Essential versus nonessential amino acids Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

12 Normal Nutrition Essential amino acidsEssential amino acids  Amino acids that must come from dietary sources  Complete vs. incomplete Complete: Contain all essential amino acids (milk, eggs, meats) Incomplete: Lack one or more essential amino acids (grains, nuts, seeds, legumes) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

13 Normal Nutrition Nonessential amino acidsNonessential amino acids  Body can synthesize if protein is available. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14 Normal Nutrition VitaminsVitamins  Organic compounds required in small amounts for normal metabolism  Function primarily in enzyme reactions  Water soluble vs. fat soluble Water soluble (vitamin C and B-complex) Fat soluble (vitamins A, D, E, K) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

15 Normal Nutrition Mineral saltsMineral salts  Magnesium, iron, calcium make up 4% of total body weight.  Necessary for building tissues  Regulation of body fluids  Assist in various body functions  Can be toxic in excessive amounts  Major and trace Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

16 Major Minerals CalciumCalcium ChlorideChloride MagnesiumMagnesium PhosphorusPhosphorus PotassiumPotassium SodiumSodium SulfurSulfur Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

17 Special Diets VegetarianVegetarian  Common element is exclusion of red meat from diet.  Well-planned diets needed to avoid deficiencies  Various reasons for following Religious Cultural Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

18 Special Diets VegansVegans  Eat only plant foods  Lack of cobalamin (vitamin B 12 ) common  Can develop megaloblastic anemia and neurologic symptoms of deficiency  Other possible deficiencies Calcium, zinc, vitamins A and D, protein, iron Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

19 Special Diets Lacto-ovo vegetariansLacto-ovo vegetarians  Eat plant foods and sometimes dairy products and eggs  Watch for vitamin and mineral deficiencies Iron deficiencyIron deficiency Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

20 Cultural Care Nurse shouldNurse should  Include cultural/ethnic considerations Dietary choices (traditional foods) Weight maintenance  Avoid cultural stereotyping  Teach dietary restrictions/changes to entire family Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

For which of the following patients is it most important for the nurse to refer to the dietitian for a complete nutritional assessment? 1. A 38-year-old diabetic who is undergoing laser eye surgery 2. A 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall 3. A 24-year-old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an asthma exacerbation 4. A 45-year-old hospitalized with nausea and abdominal pain who has had no oral intake and has received only IV fluids of D5½NS for 6 days Audience Response Question Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

Case Study Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22

23 Case Study 21-year-old woman comes into her physician’s office for her routine check-up.21-year-old woman comes into her physician’s office for her routine check-up. She states that she has switched to a vegetarian diet because she is concerned with cruelty to animals.She states that she has switched to a vegetarian diet because she is concerned with cruelty to animals. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

24 Case Study She eats mainly fast food and salads from her college cafeteria.She eats mainly fast food and salads from her college cafeteria. She consumes milk, eggs, and cheese.She consumes milk, eggs, and cheese. No abnormalities are noted on assessment.No abnormalities are noted on assessment. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

25 Discussion Questions 1.What deficiency might her diet include? 2.What foods would you stress to compensate for the lack of meat? Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

26 Discussion Questions 3.What resources could you recommend to help her learn more about a vegetarian’s needs? Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.