1. NUTRITION
NURS116

2. nutrition
A basic component of health and is essential for normal growth and development, tissue maintenance and repair, cellular metabolism, and organ function.
The giving or taking of food is part of ceremonies, celebrations, religious events, mourning, and social events.

3. Healthy people 2020
Increase proportion of adults who have a BMI
Reduce proportion of obese adults and children
Decrease saturated fat intake in population >2yrs old
Increase variety of fruits and veg in population >2
Reduce sodium intake
Increase work-site nutrition education and weight management
Offer nutrition assessment at primary care sites
Increase schools that offer nutritious food and beverages outside of school meals
Increase food security to 94% of households

4. Nutritional balance
When energy requirements are met by kcal intake of food, weight does not change
BMR- energy needed to maintain life-sustaining activities at rest
Nutrient density
Proteins, carbohydrates, fats
Vitamins, minerals, water

5. proteins
4 kcal/gram
Essential for synthesis of tissue in growth, maintenance, repair
Ingestion maintains nitrogen balance
positive nitrogen balance needed for growth, wound healing, maintaining lean muscle mass, pregnancy
Becomes energy source when insufficient carb intake
Excess intake is stored in muscle mass

6. carbohydrates
Main source of fuel for brain, skeletal muscles during exercise, RBC and WBC production, cell function of the renal medulla
Mostly plant based (ex lactose)
Insolulble fiber , a polysaccharide, is not digestible
4Kcal/gram

7. fats 9 kcal/g Most calorie dense nutrient
Deficiency occurs when fat intake is below 10% of daily nutrition

8. Water is most essential nutrient
Water is most essential nutrient. Balance occurs when intake from liquids and water-containing solids equals loss from elimination, perspiration, respiration
Vitamins essential to normal metabolism. Antioxidants include betacarotene and vits A,C, E
Minerals are inorganic elements, catalysts in biochemical reactions. Assist in acid/base balance. Selenium is a antioxidant

9. Cultural Aspects of Food

11. 25 year old man needs about 60 g protein a day

12. 25 year old man needs about 90 mg Vit C a day

13. 25 year old man needs about 4.7 grams Potassium a day

14. 25 year old man should have 1.5-2.3 g sodium per day

15. Assessing for signs of poor nutrition
Weight, BMI, muscle tone
Fatigue, dry skin, hair loss, pale conjunctiva
Apathy, confusion, cachetic
Obese
Constipation or diarrhea
Spongy or bleeding gums
Poorly healing wounds

16. Poor nutrition may be secondary to
Swallow difficulties
Deficient knowledge
Oral trauma or tooth problems
Financial difficulties
Self care deficit
Increased nutritional need in illness, burns, pregnancy
Psychological condition
Social setting

17. Special Diet Orders Gluten free (for celiac disease)
Low residue (for diverticulitis)
Carb consistent (for DM)
Low fat, low sodium (“heart healthy”)
Bland, no caffeine (for peptic ulcers)
Soft
Mechanical altered
Pureed
Thickened liquids
Fluid restrictions

18. Enteral Nutrition Provides nutrition into the GI tract
Used if pt unable to swallow or for some other reason unable to take PO, yet has functioning GI tract
Nasogastric, jejunal, or gastric
Verification by Xray before use
May give total (complete) or partial (single or elemental nutrient) nutrition
Formulas usually milk based

19. Indications for Use
N-G pts with low risk of gastric reflux./Difficulty chewing or swallowing/ A. nervosa/ short term use
Gastric (PEG or Gtube) pts with oral or facial trauma/head or neck CA/esophageal adhesions/long term use
N-I pts with gastric ileus or reflux (keo or duo tube)/short term/delayed gastric emptying
J-tube pts without a stomach, with colitis or fistulas, decreased LOC/ lying flat

20. Placement Check
Withdraw small amt GI aspirate, preferably before feedings
Check a drop on pH paper
pH 1-4 normal for stomach. pH 6 or greater in intestine
pH 6 or greater MAY MEAN lungs, intestine or stomach full of food.
Xray verification when in doubt
Surgically placed and fixed feeding tubes are considered to have “reliable” placement
Use good nursing judgment when in doubt

21. Parenteral Nutrition TPN or PPN For pts with non-functioning GI tracts
Amino acids, dextrose, electrolytes, vitamins
lipids

22. Parenteral Nutrition TPN must use central line Filter tubing
Extra nutrition for burns, sepsis, head injury or other states of high stress
GI nutrition is always preferred
Unused gut—bacteria travel into blood stream
Vit K synthesized by microflora in normal gut
Sudden discontinuation may cause hypoglycemia