1. Chapter 35 Nutrition

2. 35-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition  Nutrition is the process by which the body metabolizes and utilizes the nutrients from food.  Nutrients are digested, absorbed by the blood or lymphatic system, and transported to the body’s cells.

3. 35-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition  Digestion is the process by which ingested foods are broken down in the GI tract to smaller segments in preparation for absorption.

4. 35-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition  Absorption is the process by which the end products of digestion pass through the epithelial membranes in the small and large intestines into the blood or lymph systems.

5. 35-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition  The end products of digestion are monosaccharides (simple sugars), amino acids, glycerol, fatty acid chains, vitamins, minerals, and water.

6. 35-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition  Metabolism is the aggregate of all chemical reactions and process in every body cell, such as growth, generation of energy, elimination of wastes, and other bodily functions as they relate to the distribution of nutrients in the blood after digestion.

7. 35-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Nutrition  Metabolic rate refers to the rate of heat liberation during chemical reactions.

8. 35-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Metabolism  Energy A calorie is the unit of measurement used to express the quantity of energy released during metabolism. Energy is expressed in terms of kilocalories. Basal metabolic rate (BMR) represents the energy needed to maintain essential physiological functions.

9. 35-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Metabolism  Excretion Digestive and metabolic waste products are excreted through the intestines and rectum. Other excretory organs are the kidneys, sweat glands, skin, and lungs.

10. 35-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Water  Vitamins  Minerals  Carbohydrates  Proteins  Lipids

11. 35-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Water Accounts for 60% to 70% of an adult’s total body weight and 77% of an infant’s weight. Water and electrolytes are substances that must be acquired from the diet. Body water requirements are met through consumption of liquids and foods and the oxidation of food.

12. 35-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Vitamins Organic compounds that aid in the regulation of cellular metabolism and assist in the biochemical processes that release energy from digest food Vitamins are classified as fat-soluble or water-soluble.

13. 35-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Minerals Serve as catalysts in biochemical reactions. Classified according to daily requirement: -Macrominerals (quantities of 100mg or greater) -Microminerals (trace elements, quantities less than 100 mg)

14. 35-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Carbohydrates Organic compounds composed of carbon, hydrogen, and oxygen Primary source of energy for the brain and the preferred fuel for the body

15. 35-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Carbohydrates Monosaccharides (simple sugars) include glucose, galactose, and fructose. Disaccharides (double sugars) include sucrose, lactose, and maltose. Polysaccharides (complex sugars) include glycogen, cellulose (fiber), and starch.

16. 35-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Proteins Organic compounds that contain carbon, hydrogen, oxygen, and nitrogen atoms Essential for almost every bodily function

17. 35-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  The end products of protein digestion are amino acids.  Nonessential amino acids can be synthesized in the cells.  Essential amino acids must be ingested in the diet because they cannot be synthesized in the body.

18. 35-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Proteins are also classified as complete or incomplete. High-biological-value proteins (complete proteins) contain all the essential amino acids. Low-biological-value proteins (incomplete proteins) lack one or more essential amino acid.

19. 35-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Protein Deamination is the process of removal of (degradation) amino groups from the amino acids.

20. 35-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Other physiological processes occur during protein deamination. Gluconeogenesis Ketogenesis Nitrogen balance Positive nitrogen balance Negative nitrogen balance Obligatory loss of proteins

21. 35-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Lipids (fats) Organic compounds are the only essential nutrients that cannot mix with water and therefore, must be emulsified by molecules to be absorbed.

22. 35-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Fatty Acids Simplest form of lipids and the basic components of more complex lipids Saturated fatty acids form fats, which are glycerol esters of organic acids whose carbon atoms are joined by single bonds. Unsaturated fatty acids form glycerol esters of organic acids whose carbon atoms are joined by double or triple bonds.  Monounsaturated Fatty Acids  Polyunsaturated Fatty Acids

23. 35-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Fatty Acids Monounsaturated fatty acids are formed esters with one double or triple bond. Polyunsaturated fatty acids form esters that have many carbons unbonded to hydrogen atoms. Hydrogenated or trans-fatty acids are another category of fat that is not naturally occurring but man made.

24. 35-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nutrients  Most Important Lipids Triglycerides are composed of three fatty acid cells attached to a glycerol molecule. Phospholipids are composed of one or more fatty acid molecules and one phosphoric acid radical; they usually contain a nitrogenous base. Cholesterol is produced by the body and is considered a fat; it is also found in whole milk and egg yolk.

25. 35-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Promoting Proper Nutrition  Recommended Daily Allowances (RDAs)  The Food Guide Pyramid outlines six groups of food and the number of servings based on dietary guidelines and the basic four food groups.

26. 35-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Promoting Proper Nutrition  Societal Concerns One-third of the U.S. population is considered overweight. Obesity is becoming an epidemic. Undernutrition is a specific problem for the elderly and for people with eating disorders.

27. 35-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Weight Management  Overweight is an energy imbalance in which more food is consumed than needed.  An underweight person expends more calories than are consumed.

28. 35-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Weight Management  Anorexia nervosa (self-starvation) disrupts metabolism because of inadequate calorie intake.  Bulimia nervosa refers to food-gorging binges followed by purging of food, usually through self-induced vomiting or laxative abuse.

29. 35-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Nutrition  Age  Lifestyle  Ethnicity, Culture, and Religious Practices  Economics  Gender

30. 35-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Nutritional History 24-hour recall Food-frequency questionnaire Food record Diet history

31. 35-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Physical Examination Intake and Output (I & O) Anthropometric Measurements -Skinfold measurements -Mid-upper-arm circumference -Abdominal-girth measurement

32. 35-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Measuring the mid- upper-arm circumference

33. 35-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Diagnostic and Laboratory Data  Protein Indices  Serum Albumin  Pre-albumin  Serum Transferrin

34. 35-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Diagnostic and Laboratory Data  Hemoglobin Level  Total Lymphocyte Count  Nitrogen Balance  Urine Creatinine Excretion

35. 35-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnoses  Imbalanced Nutrition: Less Than Body Requirements  Imbalanced Nutrition: More Than Body Requirements or Risk for More Than Body Requirements

36. 35-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Other Nursing Diagnoses  Activity Intolerance  Acute Pain  Ineffective Health Maintenance  High Risk for Impaired Skin Integrity  Constipation  Impaired Swallowing

37. 35-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcome Identification and Planning  Expected outcomes are formulated to promote optimal nutritional care.  In the planning phase, the nurse identifies dietary needs and explains the need for and basis of therapy.

38. 35-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Monitoring Weight and Intake  Diet Therapy Nothing by Mouth (NPO) Clear-Liquid Liquid Soft Mechanical Soft Pureed

39. 35-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Diet Therapy Low-residue High-fiber Liberal bland Fat-controlled Sodium-restricted Lactose intolerance

40. 35-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Assistance with Feeding  Providing Nutrition Support  Nutrition Support Teams

41. 35-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Providing Enteral Nutrition Feeding tubes Insertion of enteral feeding tubes Enteral formulas

42. 35-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Enteral Feeding Routes

43. 35-43 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Administration of Enteral Feedings Safety considerations Potential complications Removal of a nasogastric tube

44. 35-44 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Providing Parenteral Nutrition (PN) Intravenous infusion of a solution directly into a vein to meet the client’s daily nutritional requirements Used to treat malnourished clients or clients who have the potential for becoming malnourished and who are not candidates for enteral support.

45. 35-45 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Components of Parenteral Nutrition Carbohydrates found primarily in form of dextrose Amino acids Lipids (fat emulsions)

46. 35-46 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Administering Medication through a Feeding Tube Types of feeding tubes Checking for tube placement Clearing the tubing of formula Checking the patency of tube Flushing the port Measuring intake and output

47. 35-47 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Complementary Therapy Nutrition is integrated as part of the therapeutic regimen of numerous types of complementary therapies. Diet and nutrition are used by many alternative modalities for the prevention and treatment of chronic diseases.

48. 35-48 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Current data is used to measure achievement of goals and outcomes.  The plan of care is modified to maximize the client’s response to therapy.