Chapter 47

Nutrition

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 47
Lesson 47.1

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2

Objectives
Differentiate between information found in the
dietary reference intake tables and the Recommended Dietary Allowances table Identify the function of macronutrients in the body Compare and contrast the Estimated Energy Requirement for a healthy male and female of similar height, weight, and level of activity Differentiate between fat-soluble and watersoluble vitamins

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Objectives (contd)
Research good dietary sources of fiber Differentiate between fat-soluble and watersoluble vitamins List five functions of minerals in the body Identify exercise guidelines currently recommended for people with different daily patterns of physical activity (sedentary, low active, active, and very active)

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Principles of Nutrition
Nutritional requirements depend on:
Age Gender Level of activity Pregnancy/lactation

Food guide pyramids

Food Guide Pyramid (1991) Healthy Eating Pyramid
Oldways www.oldwayspt.org MyPyramid www.mypyramid.gov

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 5

Dietary Reference Intakes

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Slide 6

Dietary Reference Intakes (contd)

Set of four reference values
Estimated Average Requirement (EAR) Recommended Dietary Allowances (RDAs) Adequate Intake (AI) Tolerable Upper Intake Level (UL)

Recommended Dietary Allowances (RDAs)

List average daily dietary intake levels sufficient to meet nutrient requirements of healthy individuals in a group

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Slide 7

Estimated Energy Requirement

Males versus females for the same activity level, height, weight Use the formula (Table 47-4)
(Using low active for physical activity level) 19-year-old male, 180 lb/82 kg, 5'11/177 cm (0.18 m) = 2026 19-year-old female, 125 lb/56 kg, 5'4/ 160 cm (0.16 m) = 926

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Macronutrients
Macronutrients carbohydrates, fiber, fats, proteins needed to provide energy Kilocalories (kcal): measure of energy Daily caloric needs
45% to 65% of calories should come from carbohydrates 20% to 35% of calories should come from fats 10% to 35% of calories should come from proteins

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Carbohydrates and Fiber

Carbohydrates sugars; major source of energy
Simple = monosaccharides and disaccharides Complex = polysaccharides

Fiber
Dietary fiber derived from plant sources Functional fiber undigestible carbohydrates Sources of fiber cereal bran and vegetables Total fiber = dietary fiber + functional fiber

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Fats and Proteins

Fats: lipids; bodys major form of stored energy
Monounsaturated decrease LDL; increase HDL Polyunsaturated decrease LDL; increase HDL Saturated increase LDL; increase HDL Trans increase LDL; decrease HDL Proteins: molecules composed of amino acids Essential from external sources Nonessential can be synthesized

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Vitamins and Minerals

Vitamins (total of 13)
Water soluble (9) vitamins C, B1, B2, B3, B5, B6, B12, folic acid, biotin Fat soluble (4) vitamins A, D, E, K

Minerals (e.g., calcium, iodine, iron)

Functions
Acid-base and water balance Cell membranes permeability and osmotic pressure Nerve conduction Muscle contractility Metabolism of nutrients in food
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Exercise Guidelines
Lifestyle and dietary choices combine to lead to obesity Recommended to maintain BMI range 18-25 Physical activity levels recommended
Moderate 30 minutes daily Moderate intensity 60 to 90 minutes daily High intensity 20 to 30 minutes four to seven times weekly

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 13

Chapter 47
Lesson 47.2

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 14

Objectives
Describe physical changes associated with a

malnourished state Describe nutritional assessments essential before the administration of tube feedings and parenteral nutrition Cite common laboratory and diagnostic tests used to monitor a patients nutritional status Discuss nursing assessments and interventions required during the administration of enteral nutrition Discuss home care needs of a patient being discharged on any form of enteral or parenteral nutrition
Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 15

Malnutrition
Forms
Marasmus lack of calories and protein Kwashiorkor protein deficiency Mixed kwashiorkor-marasmus inadequate protein and wasting of fat stores and muscle

Physical changes
Muscle atrophy; dry, dull hair; dry, flaky skin; fat depletion in waist, arms, legs; edema

Nutrition supplementation
Enteral administered orally or through feeding tube Parenteral administered intravenously
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Common Laboratory Tests

Prescribed before initiating parenteral or
enteral feeding Blood tests: serum prealbumin; albumin; urea nitrogen; creatinine; electrolytes; hemoglobin; hematocrit; lipids; liver function studies; glucose; total lymphocyte count; ferritin; transferrin Urine tests: specific gravity; ketones

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Enteral Feeding
Actions
Provide nutrients through GI tract by nasogastric, nasoduodenal, or nasojejunal tube, feeding gastrostomy or jejunostomy

Uses
When oral consumption is either inadequate or contraindicated (e.g., neck surgery, esophageal obstruction, stroke, etc.)

Common adverse effects

Hyperglycemia

Serious adverse effects

Pulmonary complications, diarrhea, constipation, hypersensitivity
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Parenteral Feeding
Actions
Provide balanced combination of carbohydrates, amino acids, essential fats

Uses
Inability to take nutrition enterally for 7 days; intractable vomiting and diarrhea; malabsorption syndromes; bowel surgery; coma; massive wound or burn healing

Common adverse effects

Hyperglycemia

Serious adverse effects

Hypoglycemia, fluid and electrolyte imbalance
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Monitoring Parenteral Feeding

Double-check solutions for expiration date
and bottle number Check tubing, connections, flow rates to avoid air embolism or contamination Assess venous access site for redness, swelling, drainage Observe for fluid and electrolyte imbalances, hyperglycemia

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 20

Home Care Needs for Parenteral and Enteral Nutrition

Monitor blood glucose regularly Assess for refeeding syndrome Monitor weight, vital signs, required
laboratory tests Have next container of solution prepared Do not push TPN if it gets behind schedule

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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