1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Textbook for Nursing Assistants Chapter 20: Basic Nutrition

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins How Our Bodies Use Food

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition is the process of taking in food and using it The process of nutrition involves: –Ingestion Intake of food –Digestion Breakdown of food –Absorption Transfer of nutrients into the bloodstream –Metabolism Conversion to energy Metabolism provides energy measured in units called kilocalories, more commonly known as calories Nutrition

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Food taken into our bodies is broken down into essential elements, called nutrients Nutrients provides us with energy Nutrients help our bodies to function properly Energy is measured in units called kilocalories or calories Nutrients

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrients that supply energy –Carbohydrates Basis of all diets Are the source of the body's basic fuel= GLUCOSE GLUCOSE or blood sugar=carried in the body and rapidly absorbed in every cell of the body Simple CHO so it is quickly passed from GI system to the bloodstream 1 gram of CHO = 4 calories –EX: breads, cereals, table sugar, fruits Types of Nutrients

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Nutrients Proteins –Are found in cheeses, milk, meat, fish and poultry, beans and nuts –They contain amino acids which are the building block of all body cells –Essential for growth, healing, tissue repair –1 gram of Protein = 4 calories

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Nutrients Fat (lipids) –Found in butter, cooking oils, whole milk, egg yolks, lard –Fats make foods taste BETTER! –Fat is essential to certain body functions –Fat also protect organs and helps us stay warm –1 gram fat= 9 calories

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrients Nutrients that regulate body processes –Vitamins Play a key role in body processes Water soluble Vitamin C & B-Complex Fat soluble A,D,E,K

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrients Minerals –Help provide structure in the body –Fluoride- strengthens bones and teeth –Iron-help carry O2 in RBC’s –Other essential minerals Calcium Phosphorous Iron Iodine Sodium Potassium

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrients Water –Found in many foods –Also in the form of beverages –Provides----0 calories & 0 nutrition –However- It many be more essential to life than food –You can live 3-7 without water –You can live much longer without food –Accounts for 50-60% of your total body weight

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Water Functions in the Body Water forms basis for transport of all food and nutrients in the body Transports waste out of the body in the form or urine & feces Water keep us cool when it evaporates off our skin in the form or sweat Water keeps our mucous membranes moist Water forms the basis of fluid that keeps or joints moving smoothly

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins A diet that provides the body with a balanced amount of the essential nutrients Obese –Overweight Tools to achieve a balanced diet –MyPyramid Emphasis on exercise and eating a healthy balanced diet Eat whole grains, fruits, vegetables Fat free & low fat diary products Balanced Diet

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins MyPyramid is –A guide for making daily food choices Focuses on a balance between food and physical activity Sections of MyPyramid include –Grains: make half your grains whole –Vegetables: vary your vegetables –Fruits: focus on fruits –Milk: get your calcium-rich foods –Meat & Beans: go lean with protein MyPyramid

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Food Labels Nutrition label which appear on all food products US Congress passed the Nutritional Labeling and Education Act in 1990 Labels on packaged foods must contain information about its nutritional values, serving size, and related health claims Why is reading nutritional labels a good thing?

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors that Affect Good Eating Habits Religion –Dietary restrictions are a part of many religious beliefs Culture & Geography –Culture influences what we eat –Geography will affect the availability of certain food items Finances –Persons on fixed income may not be able to afford certain foods Kitchen skills –Persons who do not know how to cook, like to cook or have no time to cook will eat out a lot

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors that Affect Good Eating Habits Individual taste –This includes personal likes and dislikes as well as allergies Appetite –The desire for food and feeling of hunger –Your state of health may control you appetite –External influences may also drive your hunger

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Diets Meal in health care facilities are prepared according to the patients nutritional needs Dietician –Professional who has degree in nutrition –Uses dietary assessment and knowledge of nutrition to plan a diet for the person that they will enjoy eating and will keep them healthy

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Diets

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Special Diets Regular diet –Well balanced with NO restrictions Mechanical Diet –Has been changed to remove foods tha are hard to chew or digest Pureed Diet/ Anti- Aspiration Diet –Blended into a smooth consistency CHO Controlled Diet –Contains limits on CHO for diabetics –The pt. nutritional and energy requirements will determine the amount of fat, proteins, CHO that are allowed

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Special Diets Clear Liquid Diet –Substances that can be poured and you can see through them Full Liquid Diet –Substances that can be poured and include milk, frozen deserts, ice cream, yogurt, soups and juices Sodium Restricted Diet –Salt restriction- may be a 100% restriction or modified –Typically written at 2gmNa Low Cholesterol Diet –Diet low in dietary saturated fats –No butter,shortening, and dietray margarine

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Meal Time

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparing for Mealtime Assist with toileting Assist with basic hand hygiene Check for denture if applicable Position the patient upright for eating- OOB in chair is best only if allowed Provide for pleasant dining experience= remove commode bedpans, urinals, emesis basins etc. Provide adeqate lighting

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Mealtime Serve meals soon after delivery to your unit Check tray label/ patient name matches!!! Assist with eating as necessary Cut and position foods for patient with dexterity and poor eyesight Allow ample time for patients to eat or to be fed Record amounts taken for I & O record – record in PERCENTAGES- the dietitian with then convert to calories

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assisting with Meals A clock face is used to reference the location of food on the tray for people with poor eyesight

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Various methods –Recording the portion of the total meal that was consumed Inform the nurse if a patient or a resident eats less than 70% of his or her meal –Recording the percentage of each food eaten Measuring and Recording Food Intake

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Involve the person in the process as much as possible Sit down and talk to the person Use a spoon, not a fork, and fill it only about 1/3 full Give the person time to chew and swallow each bite; never rush the person Offer liquids frequently between bites Feeding Dependent Patients and Residents

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Anti- Aspiration Fluids Patient with DYSPAGIA as a result of stroke, injury or dementia or neuromuscular diseases NEVER use a straw with patients on this restriction Always offer liquids slowly A thickener may be prescribed to add to fluids to create a certain consistency– such as: –Nectar –Honey –Pudding

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins When the amount of fluid taken into the body equals the amount of fluid that leaves the body, a state of fluid balance occurs Fluid balance is important for health Fluid Balance

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Dehydration occurs when there is too little fluid in the body Causes include –Diarrhea –Vomiting –Hemorrhage –Severe burns –Excessive sweating –Not drinking enough fluids Dehydration

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Edema occurs when there is too much fluid in the body Causes include –Kidney disease –Heart disease Edema

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Encourage fluid intake, unless otherwise ordered –People are more likely to drink fluids that taste good and are served at the proper temperature –Keep water pitcher filled with ice water –Offer fluids frequently to people who are bed-bound, confused, or taking pain medications A person who is not allowed to have any fluids at all is said to be on NPO status. –No water, no ice, no food, no candy, no gum Offering Fluids

32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Ways of Providing Fluids and Nutrition Intravenous Therapy –Not a source of complete nutrition –Usually contain glucose, Na, minerals and vitamins –Fluid drips into a peripheral vein via a IV catheter Enteral Nutrition –“intestine” – involves placing food into the stomach or intestines –Nasogastric Tube or NGT=into stomach via nose/throat –Gastrostomy Tube or GT= into stomach via abdomen –Jejunostomy Tube or JT=via abdomen into Jejunum –Percutaneous endoscopic gastrostomy or PEG= inserted via a scope and passed through the abdomen

33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Intravenous therapy Alternate Methods

34. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Alternate Methods

35. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Ways of Providing Fluids and Nutrition Total Parenteral Nutrition or TPN –Hyperalimentation –Given to patient who need additional nutritional supplementation and are NPO / unable to tolerate food via the GI tract –All four classes of nutrients are delivered via an IV line Fats, CHO, Proteins, minerals, vitamins, etc-- –Must be administered via a central line –PCT are NOT responsible for TPN lines

36. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Total parenteral nutrition (TPN, hyperalimentation) Alternate Methods

37. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins TELL THE NURSE When caring for patient with an IV line – Report the following: –The tubing becomes disconnected –The fluid bag is empty –The IV fluid id not dripping into the drip chamber – Blood has backed up into the IV tubing –There is swelling at the IV site –Patient complains of pain at the IV site

38. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins TELL THE NURSE When caring for patient receiving enteral nutrotion Report the following: Nausea, bloating or pain during feeding Coughing, gagging, vomiting during the feeding Abdominal distention Diarrhea Drainage from around the tube insertion site Disconnected tubing ****** If you are caring for a patient with enteral feeding you must keep the HOB elevated at least 30-44 degrees at all times- ***** if you must place the patient flat- the NURSE must be called to stop the feeding!!!!!

39. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Measuring I & O Recorded in ml’s or cc’s Must be entered into the Intake & Output Record Record every time a patient takes in fluid or when fluids leave the body Amounts are totaled at the end of each shift and then for 24 hour grand totals Record everything the patient: –Drinks –Jello, ice cream, popsicles, pudding –Enteral feeding supplements & IV – NURSE’s Responsibility 30 ml or cc’s is equal to ONE fluid ounce

40. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Measuring I & O Output –Urine, vomit, blood, wound drainage, diarrhea –Measured in ml’s or cc’s –Use graduate measuring device to measure output from urinals, bedpans, Foley's, commodes –Commode “hat” works best for patients using the commode or toilet.

41. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Output Challenges If the patient vomits somewhere other than the basin have the NURSE estimate the output Diarrhea if expelled into the toilet can also be estimated ALWAYS wear appropriate PPE when handling all output!!

42. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Calculate the following 1.10 ounces 2.5 ounces 3.8 ounces 4.4 ounces 5.1 ounce 6.6 ounces

43. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answers: 1.300 ml 2.150 ml 3.240 ml 4.120 ml 5.30 ml 6.180 ml

44. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation