Fundamentals of Nursing

Nutrition

Physiology of Nutrition

Nutrition is the process by which the body metabolizes and utilizes the nutrients from food.

Nutrients are digested by the GI system and then absorbed by the blood or lymphatic system, and transported to the body’s cells.

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.

The end products of digestion are monosaccharides (simple sugars), amino acids, glycerol, fatty acid chains, vitamins, minerals, and water.

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.

Physiology of Nutrition

Metabolism is the aggregate of all chemical reactions and processes 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.

Metabolic rate refers to the rate of heat liberation during chemical reactions.

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.

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.

Nutrients

Water Vitamins Minerals Carbohydrates Proteins Lipids

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.

Nutrients

Vitamins• Organic compounds that aid in the

regulation of cellular metabolism and assist in the biochemical processes that release energy from digested food

• Vitamins are classified as fat-soluble or water-soluble.

Nutrients

Carbohydrates• Organic compounds composed of carbon,

hydrogen, and oxygen• Primary source of energy for the brain and

the preferred fuel for the body

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.

Nutrients

Proteins• Organic compounds that contain carbon,

hydrogen, oxygen, and nitrogen atoms combine to form proteins.

• Essential for almost every bodily function.

Nutrients

The end products of protein digestion are amino acids which categorized to:

Nonessential amino acids: can be synthesized in the body.

Essential amino acids must be ingested in the diet because they cannot be synthesized in the body.

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.

• Fats are lipids that are solid at room temp.• Oils are lipids that are liquid at room temp.

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.

Promoting Proper Nutrition

The Food Guide Pyramid outlines six groups of food and the number of servings based on dietary guidelines and the basic four food groups.

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.

Weight Management

Overweight is an energy imbalance in which more food is consumed than needed.

An underweight person expends more calories than are consumed.

Factors Affecting Nutrition

Age

Lifestyle

Ethnicity, Culture

Religious Practices

Economics

Gender

Medication

Assessment

Nutritional History• 24-hour recall• Difficulty eating• Changes in appetite• Diet history & preferences• Changes in weight• General health & medical history

Assessment

Physical Examination• Intake and Output (I & O)• Anthropometric Measurements - Skinfold measurements: used to determine fat stores

- Mid-upper-arm circumference: measures fat, muscle & bone

- Abdominal-girth measurement

Assessment

Measuring the mid-upper-arm circumference

Nursing Diagnoses

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: More Than Body Requirements or Risk for More Than Body Requirements

Other Nursing Diagnoses

Activity Intolerance Acute Pain Ineffective Health Maintenance Constipation Impaired Swallowing

Implementation

Monitoring Weight and Intake Diet Therapy

• Nothing by Mouth (NPO)• Clear-Liquid diet• Full-Liquid diet• Soft diet• Diet as tolerated

Implementation

Diet Therapy• Low-residue • High-fiber • Liberal bland • Fat-controlled • Sodium-restricted • Lactose intolerance

Implementation

Assistance with Feeding Providing Nutrition Support Nutrition Support Teams

Implementation

Providing Enteral Nutrition: is an alternative method to give adequate nutrition used when the client is unable to ingest foods or the GI tract is impaired.

• Feeding tubes (e.g nasogastric tube)• Insertion of enteral feeding tubes• Enteral formulas

Enteral Feeding Routes

Implementation

Administration of Enteral Feedings• Can be intermittent or continuous• Safety considerations• Potential complications• Removal of a nasogastric tube

Implementation

Administering Medication through a Feeding Tube• Types of feeding tubes• Checking for tube placement• Checking the patency of tube• Clearing the tubing of formula• Flushing the port• Measuring intake and output

Implementation

Providing Total Parenteral Nutrition (TPN)• 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.

Implementation

Components of Parenteral Nutrition• Carbohydrates found primarily in form of

dextrose• Amino acids• Lipids (fat emulsions)

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.

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.