Chapter 44 NRS105_Collings 1 Nutrition

Elements of Energy and Nutrition NRS105_Collings 2 Basal metabolic rate (BMR) Resting energy expenditure (REE) Nutrient density Nutrients: carbohydrates, proteins, fats, water, vitamins, minerals

Carbohydrates NRS105_Collings 3 Produce 4 kcal/g Main source of energy Saccharides: simple and complex carbohydrates, fiber

Proteins NRS105_Collings 4 Produce 4 kcal/g Essential for growth, maintenance, and repair of body tissue Amino acids: essential and nonessential Complete and complementary proteins Nitrogen balance

Fats (Lipids) NRS105_Collings 5 Produce 9 kcal/g Triglycerides and fatty acids Saturated or unsaturated: monounsaturated or polyunsaturated fatty acids Essential or nonessential fatty acids

Water NRS105_Collings 6 Comprises 60% to 70% of body weight Cell function depends on a fluid environment

Vitamins NRS105_Collings 7 Essential to normal metabolism Fat-soluble: A, D, E, K Water-soluble: C and B complex

Minerals NRS105_Collings 8 Inorganic elements essential as catalysts in biochemical reactions Macrominerals Microminerals or trace elements

Digestive System NRS105_Collings 9 Anatomy and physiology Digestion Absorption Metabolism and storage of nutrients Elimination

Dietary Guidelines NRS105_Collings 10 Dietary referenced intakes (DRI’s) Recommended range of intake Food guidelines: food guide pyramid Daily values Healthy People 2010 focus area Specific diets: diabetic, gluten-free, culturally specific

Nutritional Needs throughout Growth and Development NRS105_Collings 11 Infants through school-age Breast-feeding Formulas Solid foods Food habits Adolescents Eating disorders Activities

Nutritional Needs throughout Growth and Development (cont'd) NRS105_Collings 12 Young and middle adults Pregnancy Lactation Older adults Less efficient systems Constipation, decreased absorption of nutrients Altered [diminished] sense of taste Chewing/swallowing problems

Alternative Food Patterns NRS105_Collings 13 Cultural and religious practices Vegetarian diets

Assessment: Diet History NRS105_Collings 14 Dietary intake and pattern Symptoms Allergies Taste Chewing and swallowing Appetite Elimination Medications

Assessment NRS105_Collings 15 Anthropometry [Ht, Wt, measurement, BSA] Body mass index (BMI) Ideal body weight (IBW) Laboratory tests Clinical observations Client expectations

Nursing Diagnoses NRS105_Collings 16 Risk for aspiration Alteration in fluid/electrolyte balance Imbalanced nutrition: less than/more than body requirements Self-care deficit: Feeding Knowledge deficit

Planning NRS105_Collings 17 Goals and outcomes Client’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 teaching Continuity of care – written plan

Implementation: Health Promotion NRS105_Collings 18 Client education Meal planning Food storage and preparation safety

Implementation: Acute Care NRS105_Collings 19 Advancing diets Promoting appetite Assisting clients with feeding Enteral feeding Can’t ingest, can digest/eliminate Parenteral nutrition Can’t ingest/digest/eliminate [any or all]

Enteral Feeding NRS105_Collings 20 Nasogastric, jejunal, gastric tubes Insertion and verification of placement X-ray best; 2 other methods if no X-ray Types and preparation of formulas Complete or elemental, cal/ml ordered Complications Aspiration, occlusion, imbalances

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Parenteral Nutrition NRS105_Collings 22 Initiation and management of insertion site [surgical asepsis] PIV, PICC Types of solutions Dextrose, TPN, Lipids Rate of infusion – use pump Prevention of complications Emboli, sepsis, occlusion

Implementation: Restorative Care NRS105_Collings 23 Medical nutrition therapy for specific illnesses, conditions, or injuries GI 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 NRS105_Collings 24 Short term: did pt. choose foods…...eat breakfast… go to DR Long term: did pt. gain/lose wt? Revise goals as needed Teach pt/caregiver & involve to promote independence and health Pass info to next setting [LTC]

Questions? NRS105_Collings 25