Key Points on Nutrition

Nutrition: All the processes involved in consuming and utilizing food for energy, maintenance, and growth.

Basic physiology of Ingestion, digestion, absorption, metabolism, and excretion. Basal metabolism is the amount of
nutrition: energy needed to maintain essential physiologic functions when a person is at complete rest, both
physically and mentally.

Six essential nutrients:

Carbohydrates, fats, proteins, minerals, vitamins, and water

Carbohydrates: Chief source of energy for the body. Made up of carbon, hydrogen, and oxygen. Major source of
food for all people. Helps regulate fat and protein metabolism. Daily requirements: 50 % to 60% of
an individual’s kcal intake per day. May be simple or complex, simple are monosaccharides and
disaccharides (single or double, sucrose, and lactose). Monosaccharide, glucose, is most important,
major source of energy, glucose is stored in the liver, enhances learning and memory. Complex
composed of many monosaccharides joined together (starch, dietary fiber, and glycogen). Digestion
of cooked starches begins in the mouth; little digestion occurs in the stomach, completion of
digestion in the small intestines, used completely, leaves no waste for kidney’s to excrete. Mild
deficiency results in weight loss and fatigue, serious deficiency results in ketosis.

Proteins: Only nutrient that can build, repair, and maintain body tissues, daily requirements are determined by
size, age gender, physical and emotional conditions. Recommended daily requirement 0.8g per kg,
10% to 20% of total daily calorie intake. Assists in regulating fluid balance, builds antibodies,
plasma proteins helps to control water between the circulatory system and surrounding tissues. Can
be converted into glucose and used for energy if the stores of carbohydrates and fats are insufficient.
Complete proteins contain all 9 essential amino acids. All animal fats (meat), except gelatin, are
complete. Only plant fat that is complete is soybeans. Incomplete proteins contain one or more
essential amino acids missing (plant proteins). Digestion begins in stomach, most takes place in the
small intestines. Amino acids not used to build proteins are converted to glucose, glycogen, or fat
and are stored. Complementary proteins are food sources added together to provide essential amino
acids. Nitrogen balance- amount of nitrogen eaten is equal to the amount of nitrogen excreted.
Anabolism is the building up of tissues as occurs in growth and healing. Catabolism is breaking
down of tissues into simple substances that the body can use and eliminate. Positive nitrogen balance
consumes more nitrogen than excreted desirable during periods of growth, and pregnancies.
Negative nitrogen balance consumes less nitrogen than excretes, under-nutrition, illness and trauma.
Deficiencies lead to muscle wasting, edema, lethargy, and depression. Excess proteins can result in
heart disease, colon cancer, and osteoporosis.

Lipids or Fats: Essential body nutrient, concentrated form of energy (second to carbohydrates), supplies important
tissue needs such as hormone production, structural material for cell walls, protective padding for
vital organs, insulation to maintain body temperature, covering for nerve fibers and aids in the
absorption of fat soluble vitamins ( K, A, E, D), improves flavor of food. Daily requirement 25% to
30% of daily caloric intake. Triglycerides (3 fatty acids added to glycerol) most fat in food and in
body is in the form of triglycerides (stored as adipose tissue). Phospholipids (lipoids, composed of
glycerol, fatty acids, and phosphorous). Most animal fats are saturated fats, solid at room
temperature, examples of animal fats are lard, butter, milk, cream, egg yolks, meat, poultry, and fish.
Most vegetable fats are unsaturated, liquid at room temperature, examples of vegetable fats are oils
from corn, safflower, peanut, palm, etc, nuts and avocados. Digestion occurs in small intestines.
Cholesterol is not a true fat it is a member of sterol group, body manufactures about 1000mg of
cholesterol a day mainly in the liver. Increase cholesterol levels major risk factor for coronary artery
disease. Cholesterol levels 200-239 increase risk of heart disease, greater than 240 high risk of
coronary artery disease. Deficiency in fat can result in eczema, retarded growth, weight loss, less
than 10% of daily kcal requirement. Excess fat can lead to overweight and heart disease.
Water: Most important nutrient, 50% to 60% of total body weight, daily requirement: 2000 to 3000 ml a
day, it takes 1000ml of water to process 1000kcal eaten. Water acts as a solvent, aids in digestion,
absorption circulation and excretion, transporter, carries nutrients, wastes, etc. throughout the body,
and a regulator of body temperature. Water is not digested, it is absorbed and used by the body, and
the body loses water in urine, feces, perspiration, and respiration. Deficiency of water is called
dehydration, prolonged dehydration results in death. Water is the largest single constituent of the
human body and the need for water is more urgent than the need for any other nutrient. Human body
can live one month without food but only 6 days without water.

Vitamins: Essential organic compounds that regulate body processes and are required for metabolism of fats,
proteins, and carbohydrates. Needed in small amounts. Grouped according to solubility (fat soluble,
and water soluble). Vitamins A,D, E, K are fat soluble and heat stable, sufficient dietary fat intake
and adequate fat digestion and absorption are required for proper utilization of these vitamins. Fat
soluble vitamins can be stored in excess and can be a source of toxicity, especially vitamins A, D.
Deficiency in vitamin A can cause exophthalmia, and night blindness. Absorbed in lymphatic
system. Deficiency in vitamin D can cause rickets. Water soluble vitamins C, B, thiamine, niacin and
B-complex vitamins are not stored in the body in liver and adipose tissue, Vitamin C, B12, thiamine,
and niacin deficiencies can cause scurvy, pernicious anemia, beriberi, and pellagra. Absorbed into
the circulatory system. Excess excreted in urine. Vitamin supplements will not compensate for a
poor diet. Smokers are deficient in vitamin C. Foods rich in vitamin C include cabbage, tomatoes
and oranges. Vitamins do not require digestion, vitamin deficiencies common in alcoholics, the poor,
incapacitated elders, diseases that affect the appetite, mentally retarded persons, and neglected
children.

Minerals: Inorganic compounds that help regulate body processes and or serve as structural components of the
body. Daily requirements greater than 100mg/day. Trace minerals less than 100mg/day. Unique to
each individual mineral. Major minerals and trace minerals. Trace minerals or micro-minerals
include sulfur, sodium, potassium, and magnesium. Major minerals or Macro-minerals include iron,
zinc, manganese, and iodine. Found in water, and in natural foods, as well as supplemental minerals.
Influenced by type of food, need of body, and health of absorbing tissue. Too much of a mineral can
be toxic. Excessive amounts of minerals can result in hair loss, and changes in the blood, muscles,
bones, hormones, blood vessels, and nearly all tissues. Food is the safest source of minerals.

Dietary guidelines: Food pyramid, eat a variety of foods, maintain a healthy weight, choose a diet low in saturated fat
and cholesterol, choose a diet with plenty of vegetables, fruits and grain products, use sugar, salt, and
sodium in moderation, drink alcohol in moderation.

Cardiovascular low fat, low cholesterol, increased fiber, avoid saturated fat, decrease red meat
Special diets:
consumption.
Renal diet depends on what caused the renal failure.
GI diets, avoid irritant to the GI tract that caused the illness. Nausea and vomiting, bland diet or
liquid diet, diverticulitis decreased fiber, no nuts or alcohol. Common symptoms include pain in left
lower quadrant of abdomen, with nausea, vomiting, cramping, and constipation GERD, low fat, no
fried fatty or spicy food, small frequent meals, no alcohol.
Diabetes, hypoglycemia- increased complex carbohydrates, avoid simple sugars.
Hyperglycemia-low saturated fat, protein. Seen in patients with acute Pancreatitis because of
impaired carbohydrate metabolism resulting in release of glucagon. Patients who have diabetes and
have additional illness need increased calories, increase proteins in order to heal.
Irritable bowel syndrome (IBS) - high fiber diet reduces cramping and bloating. Fluids should be
restricted with meals to reduce the risk of abdominal distention. Keeping a journal may help the
patient determine possible factors that exacerbate the symptoms.
Cancer/HIV- increase calcium, fiber, whole grains, protein, and fluid intake. Be careful of raw fruits
and vegetables, may need eternal feedings. Oral care is very important.
Nutrition across the Infancy- greatest need for nutrients in life cycle, breast milk is best- need protein, fat and
Lifespan: carbohydrates tailored to infant’s need.

Toddler-preschooler- decreased appetite, become erratic, express likes and dislikes.

School age- 6-12- uneven growth pattern, appetite improves, is still irregular, increase protein, vita
A, and C.

Adolescents’-period of rapid growth, social, physical and emotional, nutritional needs increase, peer
pressure affects diet, eat rapidly and away from home.

Girls- need increase in calcium and iron, teenage pregnancy increase need of protein, vitamins, and
minerals for girl and baby. Obesity is major concern in USA.

Young/middle adults- growth ceases, decreased BMR with each decrease, nutritional needs level
off.

Pregnancy/lactation- increase need for protein, B, and C vitamins, iron, iodine and zinc. Increase
folic acid, no alcohol, soft cheese, some fish, undercooked meat, tobacco, cocaine, cat litter, vitamin
A. 2nd and 3rd trimester needs increase 300 extra calories a day, even higher with lactation.

Elderly- decrease BMR, hormone changes, loss of teeth, decrease heat sensation, increase in
medications, caloric needs decrease, and nutrient needs are the same.

Look at the food guide pyramid. Look at the CDC website on childhood obesity. KY has 37.1%
children 10-17 who are obese, USA, 31.6%, 2007, State Health Facts.

Nursing Process: Anthropometry- weight, height, BMI, body fat. Body Mass Index (BMI)- weight in kg divided by
height in cm. Ideal Body Weight (IBW)- based on height plus or minus 10%, depending on frame
size on frame size, page 3, ATI, Nutrition.

Imbalanced nutrition less than or greater than body requirements.

Risk for Imbalanced nutrition less than or greater than body requirements. Imbalance nutrition as the
etiology.
Anxiety r/t imbalanced nutrition.
Activity intolerance.
Knowledge deficit.
Goal is to restore or optimize nutritional status. Implementation-

Enteral nutrition- tube feeding, g-tube or NGT, PEG tube.

*Pt safety is essential with enteral feedings, no food coloring, check residual, keep head of bed
elevated, confirm placement,
Risk for aspiration is appropriate nursing diagnosis.

Parenteral Nutrition- IV, TPN, hypertonic, high concentration. See page 1454, 1455 in Taylor.
Check blood sugars, usually patient has a central line for TPN. Check page 1459-1462 in Taylor for
care plan information.

Nursing Process Dietary and health history- think Determine-

continued: D- disease, acute or chronic,
E- eating, poor or good
T-tooth loss/ mouth pain
E-economics
R- reduce social contact
M- multiple medications
I- involuntary weight loss or gain
N-needs assistance or self care
 E- elder > 80.
Remember patient’s have specific needs based on culture, religion, socioeconomics, fads, and
superstitions. Safety of food is important, proper storage, proper sanitation, proper cooking.
Don’t forget to ask about food allergies.

Additional information: Clinical observation- See page 1437, 1439 in Taylor.

Albumin- normal 3.5-5.5g/dl,

Important lab tests: **Decrease means malnutrition or mal-absorption. Determines protein status. Patient at risk for
poor nutritional status when serum albumin levels are decreased.

Pre-albumin- normal 23-43mg/dl,

**Decrease protein depletion, malnutrition, indicates short term nutritional status, useful to
determine daily changes in protein status.

Transferrin- normal 240-480mg/dl, decrease anemia, protein deficiency, determines protein

status, iron transporting protein.

Review questions: 1. Which of the following alterations in dietary intake is recommended for a patient with irritable
bowel syndrome?

A. High fiber diet.

B. Small frequent meals.
C. Avoid caffeine, alcohol, and chocolate.
D. Low fat diet.

2. A young adult, who presented with nausea, vomiting, abdominal bloating, and cramping, is
diagnosed with IBS and is ready for discharge. Which of the following statements indicates that
the patient understands discharge instructions?
A. “Small, low-fat frequent meals are best for me.”
B. “I will eliminate alcohol and caffeine consumption.”
C. “I need to eat a high fiber diet and drink plenty of water.”
D. “I should not drink fluids with meals.”

3. An elderly patient presents with complaint of pain in the left lower quadrant of abdomen with
nausea, vomiting, and constipation. Which of the following is the likely cause?
A. Appendicitis.
B. Pancreatitis.
C. Cholecystitis.
D. Diverticulitis.

4. When caring for a person with acute Pancreatitis, the nurse would expect which of the
following abnormal lab values?
A. Hypoglycemia.
B. Hyperglycemia.
C. Hypernatremia.
D. Hyponatremia.