CH 45 potter Nutrition Flashcards
is a basic component of health and is essential for normal growth and development, tissue maintenance and repair, cellular metabolism, and organ function.
Nutrition
This term means that all household members have access to sufficient, safe, and nutritious food to maintain a healthy lifestyle.
food security
in poor patient outcomes such as longer hospital admissions due to delayed healing or adverse effects on health conditions
Decreased food security or access to healthy nutrition can result
uses nutrition therapy and counseling to manage diseases
Medical nutrition therapy (MNT)
diet therapy is often the
major treatment for disease control for type 1 diabetes mellitus (DM) or mild hypertension
such as enteral nutrition (EN) or parenteral nutrition (PN)
severe inflammatory bowel disease require specialized nutrition support like
provide energy for cellular metabolism and repair, organ function, growth, and body movement.
The body requires fuel to
is the energy needed at rest to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature) for a specific amount of time
basal metabolic rate (BMR)
such as age, body mass, gender, fever, starvation, menstruation, illness, injury, infection, activity level, and thyroid function
Factors affect energy requirements.
is the amount of energy you need to consume over a 24-hour period for your body to maintain all of its internal working activities while at rest.
resting energy expenditure (REE), or resting metabolic rate
illness, pregnancy, lactation, and activity level.
Factors that affect metabolism include
we gain weight.
When the kilocalories ingested exceed our energy demands
we lose weight.
if the kilocalories ingested fail to meet our energy requirements
our weight does not change
kilocalories (kcal) of the food we eat meet our energy requirements
are the elements necessary for the normal function of numerous body processes
Nutrients
carbohydrates, proteins, fats, water, vitamins, and minerals.
We meet energy needs through the intake of a variety of nutrients:
to the proportion of essential nutrients to the number of kilocalories
nutrient density of food refers
provide a large number of nutrients in relationship to kilocalories.
High–nutrient dense foods such as fruits and vegetables
r are high in kilocalories but nutrient poor.
Low–nutrient dense foods such as alcohol or suga
composed of carbon, hydrogen, and oxygen, are the main source of energy in the diet
Carbohydrates (nutrient)
4 kcal/g
Each gram of carbohydrate produces
serves as the main source of fuel (glucose) for the brain, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla.
Carbohydrates function
plant foods, except for lactose (milk sugar).
We obtain carbohydrates primarily from
carbohydrate units, or saccharides.
Carbohydrate classification occurs according to their
such as glucose (dextrose) or fructose
-cant be broken into more basic unit
Monosaccharides (Carbohydrate)
such as sucrose, lactose, and maltose
-are composed of two monosaccharides and water
Disaccharides
is the classification for both monosaccharides and disaccharides;
-found primarily in sugars
Simple carbohydrate
such as glycogen make up carbohydrate units too
They are insoluble in water and digested to varying degrees.
Polysaccharides
Polysaccharides
complex carbohydrates
Starches, glycogen, fiber
Polysaccharides
is the structural part of plants that is not broken down by our digestive enzymes
Fiber, a polysaccharide
that it does not contribute calories to the diet.
inability to break down fiber means
insoluble fibers, including cellulose, hemicellulose, and lignin, .
polysaccharides that are not digestible
barley, cereal grains, cornmeal, and oats.
Soluble fibers dissolve in water and include
a source of energy (4 kcal/g);
Proteins provide (nutrient)
essential for the growth, maintenance, and repair of body tissue.
Proteins function
Collagen, hormones, enzymes, immune cells, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA) are
all made of protein
blood clotting, fluid regulation, and acid-base balance .
require proteins
amino acid, consisting of hydrogen, oxygen, carbon, and nitrogen.
simplest form of protein is the
are histidine, lysine, and phenylalanine
indispensable (necessary) amino acids (provided thru diet not body)// simple form protein
are alanine, asparagine, and glutamic acid.
amino acids synthesized in the body (dispensable)
Albumin and insulin are simple proteins because they contain only amino acids or their derivatives.
Simple proteins
combination of a simple protein with a nonprotein substance produces a complex protein such as lipoprotein, formed by a combination of a lipid and a simple protein.
Complex protein
contains all essential amino acids in sufficient quantity to support growth and maintain nitrogen balance
complete protein, also called a high-quality protein (all 9- full indispensable proteins)
animal sources, such as fish, poultry, beef, milk, cheese, and eggs, but they can also come from plant sources, such as soy
Most complete proteins come from
are missing one or more of the nine indispensable amino acids and include grains, seeds and nuts, legumes, and vegetables.
Incomplete proteins
are pairs of incomplete proteins that, when combined, supply the total amount of protein provided by complete protein sources.
Complementary proteins
is a byproduct of protein catabolism
Nitrogen
that the intake and output of nitrogen are equal
Achieving nitrogen balance means
. When the intake of nitrogen is greater than the output, the body is in
positive nitrogen balance.
growth, normal pregnancy, maintenance of lean muscle mass and vital organs, and wound healing.
Positive nitrogen balance is required for
build, repair, and replace body tissues
body uses nitrogen to
when the body loses more nitrogen than it gains (e.g., with infection, burns, fever, starvation, head injury, and trauma).
Negative nitrogen balance occurs
of body tissue destruction or loss of nitrogen-containing body fluids.
increased nitrogen loss is the result
are the most calorie-dense nutrient, providing 9 kcal/g.
Fats (lipids) // nutrient
triglycerides and fatty acids
Fats are composed of
circulate in the blood and are composed of three fatty acids attached to a glycerol.
Triglycerides (composition of fat)
chains of carbon and hydrogen atoms with an acid group on one end of the chain and a methyl group at the other
Fatty acids are composed of (part of triglyceride which is a composition of fat)
in which each carbon in the chain has two attached hydrogen atoms, or
Fatty acids can be saturated
, in which an unequal number of hydrogen atoms are attached and the carbon atoms attach to one another with a double bond
unsaturated (fatty acids)
have one double bond,
Monounsaturated fatty acids
have two or more double carbon bonds.
polyunsaturated fatty acids
essential or nonessential
Fatty acids are also classified as
, an unsaturated fatty acid, is the only essential fatty acid in humans
Linoleic acid
Linolenic acid and arachidonic acid, other
types of unsaturated fatty acids, are important for metabolic processes.
10% of daily nutrition.
Deficiency occurs when fat intake falls below
saturated fatty acids,
Most animal fats have high proportions of
unsaturated and polyunsaturated fatty acids.
vegetable fats have higher amounts of
cell function depends on a fluid environment.
Water is critical because
60% to 70% of total body weight
Water makes up
water than those who are obese because muscle contains more water than any other tissue except blood
. People who are lean have a greater percent of total body
food oxidation.
Digestion produces fluid during
elimination, respiration, and sweating
In a healthy individual fluid intake from all sources equals fluid output through
are organic substances present in small amounts in foods that are essential to normal metabolism
Vitamins (nutrient)
chemicals that act as catalysts in biochemical reactions
Vitamins (nutrient) function
When there is enough of any specific vitamin to meet the catalytic demands of the body, the rest of the vitamin supply acts as a free chemical and is often toxic to the body.
Vitamins (nutrient) function
free radicals, which produce oxidative damage to body cells and tissues.
-Researchers think that oxidative damage increases a person’s risk for various cancers
vitamins neutralize substances called
.beta-carotene and vitamins A, C, and E
Antioxidant vitamins include
fresh foods that have minimal exposure to heat, air, or water before their use.
Vitamin content is usually highest in
fat soluble or water soluble.
Vitamin classifications include
the fatty compartments of the body. People acquire vitamins primarily through dietary intake, although vitamin D also comes from the sun.
fat-soluble vitamins (A, D, E, and K) are stored in //(Vitamin classification)
body has a high storage capacity for fat-soluble vitamins.
toxicity is possible when a person takes large doses of fat-soluble vitamins because
from megadoses (intentional or unintentional) of supplemental vitamins, excessive amounts in fortified food, and large intake of fish oils.
Hypervitaminosis of fat-soluble vitamins results
vitamin C and the B complex (which is eight vitamins).
water-soluble vitamins are// (Vitamin classification)
body does not store water-soluble vitamins; thus, we need them provided in our daily food intake. Water-soluble vitamins absorb easily from the GI tract. Although they are not stored, toxicity can still occur.
water-soluble vitamins function// (Vitamin classification)
are inorganic elements essential to the body as catalysts in biochemical reactions.
Minerals (nutrient)
micromineral or macromineral
Minerals classified as
when the daily requirement is 100 mg or more and
macrominerals (classification of mineral)
when less than 100 mg is needed daily
microminerals or traceelements (classification as mineral)
help to balance the pH of the body, and specific amounts are necessary in the blood and cells to promote acid-base balance.
- Interactions occur among trace minerals
- For example, excess of one trace mineral sometimes causes deficiency of another.
Macrominerals (classification of mineral)
is a trace element that also has antioxidant properties. .
Selenium (mineral classified as micromineral)
Silicon, vanadium, nickel, tin, cadmium, arsenic, aluminum, and boron are]
trace elements (mineral classified as micromineral aka trace mineral)
Arsenic, aluminum, and cadmium
minerals (trace elements) that can have toxic effects
is the mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form
Digestion of food
are the protein-like substances that act as catalysts to speed up chemical reactions.
Enzymes
saliva moistens and lubricates the food
-amylase digests carbohydrates
salivary glands
Breaks up food particles
-assists in producing spoken language
Mouth
swallows
pharynx
transports food
esophagus
Stores and chums food
- HCL activates enzymes, breaks up food, kills germs,
- mucus protects stomach wall
- limited absorption
stomach
Stores and concentrates bile
Gallbladder
Breaks down and builds up many biological molecules
- stores vitamins and iron
- Destroys old blood cells
- Destroys poisons
- produces bile to aid digestion
Liver
Hormones regulate blood glucose levels
-Bicarbonates neutralize stomach acid
Pancreas
Reabsorbs some water, ions, and vitamins
-forms and stores feces
Large intestine
completes digestion
- mucus protects gut wall
- absorbs nutrients, most water
Small intestine
stores and expels feces
Rectum
opening for elimination of feces
anus
have one specific function.
-Each enzyme works best at a specific pH
Most enzymes
pH levels.
secretions of the GI tract have very different
is relatively neutral
Saliva PH is
is highly acidic
gastric juice PH
are alkaline.
secretions of the small intestine PH
- Enzyme activity depends on the mechanical breakdown of food to increase its surface area for chemical action.
- Hormones regulate the flow of digestive secretions needed for enzyme supply. Physical, chemical, and hormonal factors regulate the secretion of digestive juices and the motility of the GI tract. Nerve stimulation from the parasympathetic nervous system (e.g., the vagus nerve) increases GI tract action
mechanical, chemical, and hormonal activities of digestion are interdependent.
in the mouth, where chewing mechanically breaks down food.
Digestion begins
, a hormone that triggers parietal cells to secrete hydrochloric acid (HCl).
chief cells in the stomach secrete pepsinogen, and the pyloric glands secrete gastrin
which is necessary for absorption of vitamin B12 in the ileum
parietal cells also secrete HCl and intrinsic factor (IF),
approximately 3 hours, with a range of 1 to 7 hours.
stomach acts as a reservoir where food remains for
bw distal of stomach and duodenum
pyloric sphincter
distal of stomach
antrum
beginning of stomach
fundus
an acidic, liquefied mass called chyme
once food hits duodenum it becomes
with bile, intestinal juices, and pancreatic secretions. .
Chyme flows into the duodenum and quickly mixes
Secretin activates release of bicarbonate from the pancreas, raising the pH of chyme.
The small intestine secretes the hormones secretin and cholecystokinin (CCK).
the pancreas and gallbladder
CCK inhibits further gastrin secretion and initiates release of additional digestive enzymes from
amylase to digest starch; lipase to break down emulsified fats; and trypsin, elastase, chymotrypsin, and carboxypeptidase to break down proteins.
Pancreatic secretions contain six enzymes:
(e.g., sucrase, lactase, maltase, lipase, and peptidase) to facilitate digestion.
Epithelial cells in the small intestinal villi secrete enzymes
The small intestine, lined with fingerlike projections called , is the primary absorption site for nutrients.
-Villi increase the surface area available for absorption.
villi
passive diffusion, osmosis, active transport, and pinocytosis
The body absorbs nutrients by means of
An energy-dependent process, typically driven by adenosine triphosphate (ATP). During the process particles move from an area of lower concentration to an area of greater concentration (against the concentration gradient).
Active transport (Mechanisms for Intestinal Absorption of Nutrients)
The force by which particles move outward from an area of greater concentration to one of lesser concentration. The particles do not need a special “carrier” to move outward in all directions.
Passive diffusion (Mechanisms for Intestinal Absorption of Nutrients)
Movement of water through a semipermeable membrane that separates solutions of different concentrations. Water moves to equalize the concentration pressures on both sides of the membrane.
Osmosis (Mechanisms for Intestinal Absorption of Nutrients)
Engulfing of large molecules of nutrients by the absorbing cell when the molecule attaches to the absorbing cell membrane.
Pinocytosis (Mechanisms for Intestinal Absorption of Nutrients)
in the small intestine.
Absorption of carbohydrates, protein, minerals, and water-soluble vitamins occurs
in the small intestine.
-Then the nutrients are processed in the liver and released into the portal vein circulation.
Absorption of carbohydrates, protein, minerals, and water-soluble vitamins occurs
lymphatic circulatory systems through lacteal ducts at the center of each microvilli in the small intestine.
Fatty acids are absorbed in the
the small intestine
Approximately 85% to 90% of water is absorbed in
The GI tract manages approximately 8.5 L of GI secretions
- 1.5 L of oral intake daily.
- The small intestine resorbs 9.5 L, and the colon absorbs approximately 0.4 L. Elimination of the remaining 0.1 L occurs via feces
water distribution when absorbed
the colon, and bacteria synthesize vitamin K and some B-complex vitamins
electrolytes and minerals are absorbed in
all the biochemical reactions within the cells of the body.
Metabolism refers to
anabolic (building) or catabolic (breaking down)
Metabolic processes are
is the building of more complex biochemical substances by synthesis of nutrients
-It occurs when an individual adds lean muscle through diet and exercise
Anabolism (metabolic process)
tissues, hormones, and enzymes
Amino acids are anabolized into (protein)
in positive nitrogen balance.
Normal metabolism and anabolism are physiologically possible when the body is
is the breakdown of biochemical substances into simpler substances and occurs during physiological states of negative nitrogen balance. Starvation is an example of catabolism when wasting of body tissues occurs.
Catabolism
Carbohydrates, protein, and fat metabolism produce chemical energy and maintain a balance between anabolism and catabolism.
Through the chemical changes of metabolism, the body converts nutrients into a number of required substances
Muscle contraction involves mechanical energy,
-nervous system function involves electrical energy, and the mechanisms of heat production involve thermal energy.
to carry out the work of the body, the chemical energy produced by metabolism converts to other types of energy by different tissues.
fat, stored as adipose tissue.
major form of body reserve energy is
muscle mass.
Protein is stored in
ketones for energy when dietary carbohydrates (glucose) are not adequate.
All body cells except red blood cells and neurons oxidize fatty acids into
fasting (e.g., during sleep). It is stored in small reserves in liver and muscle tissue.
Glycogen, synthesized from glucose, provides energy during brief periods of
- Catabolism of glycogen into glucose, carbon dioxide, and water (glycogenolysis)
- Anabolism of glucose into glycogen for storage (glycogenesis)
- Catabolism of amino acids and glycerol into glucose for energy (gluconeogenesis)
Nutrient metabolism consists of three main processes:
peristalsis, and water maintains consistency.
Exercise and fiber stimulate
cellulose and similar indigestible substances, sloughed epithelial cells from the GI tract, digestive secretions, water, and microbes.
Feces contain
present evidence-based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age-group
Dietary reference intakes (DRIs)
- The estimated average requirement (EAR) is the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50% of the population on the basis of age and gender. The recommended dietary allowance
- (RDA) represents the average needs of 98% of the population, not the exact needs of the individual. The adequate intake
- (AI) is the suggested intake for individuals based on observed or experimentally determined estimates of nutrient intakes and is used when there is not enough evidence to set the RDA.
- The tolerable upper intake level (UL) is the highest level that likely poses no risk of adverse health events. It is not a recommended level of intake
There are four components to the DRIs.
grains, vegetables, fruits, dairy products, and meats
The US Department of Health and Human Services (USDHHS) and the US Department of Agriculture (USDA) published the Dietary Guidelines for Americans 2015-2020 and provide average daily consumption guidelines for the 5 food groups:
a basic guide for making food choices for a healthy lifestyle. It includes guidelines for balancing calories; decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars
ChooseMyPlate provides
The referenced daily intakes (RDIs) are the first set, comprising protein, vitamins, and minerals based on the RDA.
-The daily reference values (DRVs) make up the second set and consist of nutrients such as total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium.
FDA first established two sets of reference values.
of development, body composition, activity levels, pregnancy and lactation, and the presence of disease
Individual caloric and nutrient requirements vary by stage
use predictive equations that take into account some of these factors to estimate patients’ nutritional requirements.
Registered dietitians (RDs)
25 to 29
Overweight is defined as having a BMI of
30 or greater
obesity is defined as a BMI of
such as sedentary lifestyle, overeating, and genetics
Obesity is often associated with a number of factors
healthy eating and participation in exercise or other activities of healthy living, Lack of access to full-service grocery stores, high cost of healthy food, widespread availability of less healthy foods in fast-food restaurants, 1107widespread advertising of less healthy food, and lack of access to safe places to play and exercise are environmental factors that contribute to obesity
Environmental factors can limit a person’s likelihood of
Rapid growth and high protein, vitamin, mineral, and energy requirements
mark the developmental stage of infancy
is 7 to 71⁄2 lb. (3.2 to 3.4 kg)
average birth weight of an American baby
90 to 110 kcal/kg of body weight per day, with premature infants needing 105 to 130 kcal/kg per day
Infants need an energy intake of approximately
simple carbohydrates, proteins, and a moderate amount of emulsified fat.
full-term newborn is able to digest and absorb
a large part of total body weight is water.
Infants need about 100 to 120 mL/kg/day of fluid because
, including fewer food allergies and intolerances; fewer infant infections; easier digestion; convenience, availability, and freshness; temperature always correct; economical because it is less expensive than formula; and increased time for mother and infant interaction.
Breastfeeding has multiple benefits for both infant and mother
whey, soy, cow’s milk base, casein hydrolysate, or elemental amino acids.
Protein in the formula is typically
soy protein–based formulas instead
Infants with allergies or an intolerance to cow’s milk should consume
It is too concentrated for an infant’s kidneys to manage, increases the risk of milk-product allergies, and is a poor source of iron and vitamins C and E
Infants should not have regular cow’s milk during the first year of life.
honey and corn syrup products because they are potential sources of the botulism toxin, which increases the risk of infant death
children under 1 year of age should never ingest
semisolid food to be introduced.
- For infants 4 to 11 months, cereals are the most important nonmilk source of protein
Iron-fortified cereals are typically the first
food and self-feeding
development of fine-motor skills of the hand and fingers parallels an infant’s interest in
wheat, egg white, nuts, citrus juice, and chocolate should happen later in the infant’s life
Introducing foods that have a high incidence of causing allergic reactions such as
, approximately 4 to 7 days apart, to identify allergies. It is best to introduce new foods before milk or other foods to avoid satiety
caregivers should introduce new foods one at a time
toddler years (1 to 3 years)
The growth rate slows during
A toddler needs fewer kilocalories but an increased amount of protein in relation to body weight; consequently, appetite often decreases at 18 months of age. Toddlers exhibit strong food preferences and become picky eaters.
The growth rate slows during toddler years (1 to 3 years).
Small, frequent meals consisting of breakfast, lunch, and dinner with three interspersed high nutrient–dense snacks help improve nutritional intake
toddlers meal plan
healthy bone growth.
Calcium and phosphorus are important for
milk anemia because milk is a poor source of iron.
Toddlers who consume more than 24 ounces of milk daily in place of other foods sometimes develop
2 years to make sure that there is adequate intake of fatty acids necessary for brain and neurological development.
Toddlers need to drink whole milk until the age of
such as hot dogs, hard candy, nuts, grapes, raw vegetables, and popcorn because they present a choking hazard
Avoid certain foods for toddlers
are similar to those for toddlers. They consume slightly more than toddlers, and nutrient density is more important than quantity.
Dietary requirements for preschoolers (3 to 5 years)
grow at a slower and steadier rate, with a gradual decline in energy requirements per unit of body weight.
- need adequate protein and vitamins A and C.
- Physical activity level decreases consistently, and consumption of high-calorie
School-age children, 6 to 12 years old,
- use of food as a coping mechanism for stress or boredom or as a reward or celebration, and family and socioeconomic factors
- Childhood obesity contributes to medical problems related to the cardiovascular system, endocrine system, and mental health. With the increase in obesity, the incidence of type 2 diabetes in children is also increasing
School-age children, 6 to 12 years old, food impacting health
to nutritional needs than chronological age.
During adolescence physiological age is a better guide
Energy needs increase to meet greater metabolic demands of growth. Daily requirement of protein also increases. Calcium is essential for the rapid bone growth of adolescence, and girls need a continuous source of iron to replace menstrual losses. Boys also need adequate iron for muscle development. Iodine supports increased thyroid activity, and the use of iodized table salt ensures availability. B-complex vitamins are necessary to support heightened metabolic activity.
Adolescence nutrition
, including concern about body image and appearance, desire for independence, eating at fast-food restaurants, peer pressure, and fad diets.
factors that impact adolescent’s diet
Nutritional deficiencies often occur in adolescent girls because of dieting and use of oral contraceptives. An adolescent boy’s diet is often inadequate in total kilocalories, protein, iron, folic acid, B vitamins, and iodine
- onset of eating disorders such as anorexia nervosa or bulimia nervosa often occurs during adolescence.
factors that impact adolescent’s diet
Vitamin and mineral supplements are not required, but intake of iron-rich foods is required to prevent anemia.
adolescent’s diet
of anatomical and physiological immaturity
Pregnancy occurring within 4 years of menarche places a mother and fetus at risk because
- teens tolerate suggestions better than rigid directions.
- calcium, iron, and vitamins A and C.
- The American College of Obstetricians and Gynecologists recommends prenatal vitamin and mineral supplements.
The diet of pregnant adolescents is often deficient in
There is a reduction in nutrient demands as the growth period ends. Mature adults need nutrients for energy, maintenance, and repair.
-Adult women who use oral contraceptives often need extra vitamins. Iron and calcium intake continue to be important.
young and middle age adults
- food intake in the first trimester includes balanced parts of essential nutrients with emphasis on quality.
- Protein intake throughout pregnancy needs to increase to 60 g daily.
- Calcium intake is especially critical in the third trimester, when fetal bones mineralize.
- Providing iron supplements to meet the mother’s increased blood volume, fetal blood storage, and blood loss during delivery is important.
pregnancy nutrition
Folic acid intake is particularly important for DNA synthesis and the growth of red blood cells.
- Inadequate intake can lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia
- Women of childbearing age need to consume 400 mcg of folic acid daily, increasing to 600 mcg daily during pregnancy.
- Prenatal care usually includes vitamin and mineral supplementation to ensure daily intakes; however, pregnant women should not take additional supplements beyond prescribed amounts.
pregnancy nutrition
500 kcal/day above the usual allowance because the production of milk increases energy requirements. Protein requirements during lactation are greater than those required during pregnancy.
- The need for calcium remains the same as during pregnancy.
- There is an increased need for vitamins A and C.
- Daily intake of water-soluble vitamins (B and C) is necessary to ensure adequate levels in breast milk.
Women who are lactating need
a decreased need for energy because their metabolic rate slows with age.
Adults 65 years and older have
appetite, taste, smell, and the digestive system affect nutrition
Age-related changes in
Income is significant because living on a fixed income often reduces the amount of money available 1109to buy food. Health is another important influence that affects a person’s desire and ability to eat. Lack of transportation or ability to get to the grocery store because of mobility problems contributes to inability to purchase adequate and nutritious food.
negatively impact older adults from adequate nutrition
-teeth and gums, reduced saliva production, atrophy of oral mucosal epithelial cells, increased taste threshold, decreased thirst sensation, reduced gag reflex, and decreased esophageal and colonic peristalsis
• The presence of chronic illnesses (e.g., diabetes mellitus, end-stage renal disease, cancer) often affects nutrition intake.
• Adequate nutrition in older adults is affected by multiple causes, such as lifelong eating habits, culture, socialization, income, educational level, physical functional level to meet activities of daily living (ADLs), loss, dentition, and transportation
• Adverse effects of medications cause problems such as anorexia, gastrointestinal bleeding, xerostomia, early satiety, and impaired smell and taste perception
• Cognitive impairments such as delirium, dementia, and depression affect ability to obtain, prepare, and eat healthy foods.
Older AdultsFactors Affecting Nutritional Status
such as joint infections, ischemic stroke, cardiovascular disease, DM, and aspiration pneumonia
Poor oral hygiene and periodontal disease are potential risk factors for systemic diseases
confusion; weakness; hot, dry skin; furrowed tongue; rapid pulse; and high urinary sodium.
Symptoms of dehydration in older adults include
and grapefruit juice because they alter absorption of many drugs.
Caution older adults to avoid grapefruit
and grapefruit juice because they alter absorption of many drugs.
Caution older adults to avoid grapefruit (fruit & juice)
, such as dairy products, green leafy vegetables, soy, nuts, fish (canned sardines and salmon with bones), and fortified grains, help protect against osteoporosis
Foods rich in calcium
improving strength and balance, strengthening bone health, and preventing bone fractures and falls.
. Vitamin D supplements are important for
home-delivered or congregate meal services. This program requires meals to provide at least one-third of the DRI for an older adult and meet the Dietary Guidelines for Americans
The USDHHS Administration on Aging (AOA) requires states to provide nutritional screening services to older adults who benefit from
predominates in many cultures. The origin appears to be from Hippocratic beliefs concerning health and the four humors. Arabs were keepers of this knowledge during the Dark Ages and later influenced the Spanish to adopt this belief system in the later Middle Ages. The foundation of the theory is keeping harmony with nature by balancing “cold,” “hot,” “wet,” and “dry.” Some cultures believe that hot is warmth, strength, and reassurance, whereas cold is menacing and weak.
theory of hot and cold foods
rice, grain cereals, alcohol, beef, lamb, chili peppers, chocolate, cheese, temperate zone fruits, eggs, peas, goat’s milk, cornhusks, oils, onions, pork, radishes, and tamales.
. Hot foods include
beans, citrus fruits, tropical fruits, dairy products, most vegetables, honey, raisins, chicken, fish, and goat.
cold foods are
• Specific conditions such as menstruation, cancer, pneumonia, earache, colds, paralysis, headache, or rheumatism, which are
cold illnesses and require hot foods.
• Other conditions such as pregnancy, fever, infections, diarrhea, rashes, ulcers, liver problems, constipation, kidney problems, or sore throats,
hot conditions and require cold foods.
is the consumption of a diet consisting predominantly of plant foods
Vegetarianism
(avoid meat, fish, and poultry but eat eggs and milk),
. Some vegetarians are ovolactovegetarian
(drink milk but avoid eggs)
lactovegetarians
(consume only plant foods).
vegans
protein and vitamin deficiencies, such as a lack of vitamin B12
vegetarian diet are especially at risk for
is an essential part of an initial assessment
Nutrition screening
Screening a patient is a quick method of identifying malnutrition or risk of malnutrition
using simple tools
the current condition and typically include objective measures such as height, weight, weight change, primary diagnosis, and the presence of other co-morbidities
Nutrition screening tools gather data on
uses the patient history, weight, and physical assessment data to assess nutritional status
Subjective Global Assessment (SGA)
a simple, inexpensive technique that is able to predict nutrition-related complications
SGA (Subjective Global Assessment)
screens older adults in home care programs, nursing homes, and hospitals. The tool has 18 items divided into screening and assessment. If a patient scores 11 or less on the screening part, the health care provider completes the assessment part.
Mini Nutritional Assessment (MNA)
is a systematic method of measuring the size and makeup of the body
Anthropometry
provides an estimate of what a person should weigh.
ideal body weight (IBW)
1 lb (0.45 kg).
One pint or 500 mL of fluid equal
the ratio of height-to-wrist circumference, mid–upper arm circumference (MAC), triceps skinfold (TSF), and mid–upper arm muscle circumference (MAMC)
anthropometric measurements often obtained by RDs help identify nutritional problems. These include
measures weight corrected for height and serves as an alternative to traditional height-weight relationships.
Body mass index (BMI)
dividing a patient’s weight in kilograms by height in meters squared: weight (kg) divided by height2 (m2).
Calculate BMI by
measures of plasma proteins such as albumin, transferrin, prealbumin, retinol-binding protein, total iron-binding capacity, and hemoglobin.
Common laboratory tests used to study nutritional status include
is 21 days, transferrin is 8 days, prealbumin is 2 days, and retinol-binding protein is 12 hours
metabolic half-life of albumin
hydration; hemorrhage; renal or hepatic disease; large amounts of drainage from wounds, drains, burns, or the GI tract; steroid administration; exogenous albumin infusions; age; and trauma, burns, stress, or surgery.
Factors that affect serum albumin levels include
chronic illnesses
Albumin level is a better indicator for
acute conditions
prealbumin level is preferred for
serum protein status
Nitrogen balance is important in determining
determine nitrogen output.
-For patients with diarrhea or fistula drainage, estimate a further addition of 2 to 4 g of nitrogen output
analysis of a 24-hour urine urea nitrogen (UUN) to
subtracting the nitrogen output from the nitrogen intake
Calculate nitrogen balance by
health status; age; cultural background, religious food patterns, socioeconomic status; personal food preferences; psychological factors; use of alcohol or illegal drugs; use of vitamin, mineral, or herbal supplements; prescription or over-the-counter (OTC) drugs; and the patient’s general nutrition knowledge.
nursing assessment of nutrition includes
This allows you to calculate nutritional intake and to compare it with DRI to see whether the patient’s dietary habits are adequate.
In an outpatient setting, have a patient keep a 3- to 7-day food diary.
refers to difficulty swallowing
Dysphagia
aspiration pneumonia, dehydration, decreased nutritional status, and weight loss.
Complications of dysphagia include
disability or decreased functional status, increased length of stay and health care costs, increased likelihood of discharge to institutionalized care, and increased mortality
Dysphagia leads to
They include cough during eating; change in voice tone or quality after swallowing; abnormal movements of the mouth, tongue, or lips; and slow, weak, imprecise, or uncoordinated speech. Abnormal gag, delayed swallowing, incomplete oral clearance or pocketing, regurgitation, pharyngeal pooling, delayed or absent trigger of swallow, and inability to speak consistently are other signs of dysphagia.
warning signs of dysphagia
is aspiration that occurs in patients with neurological problems that leads to decreased sensation. It often occurs without a cough, and symptoms (for example, adventitious breath sounds, slight fever) usually do not appear for 24 hours. Silent aspiration is common in patients with dysphagia following stroke
Silent aspiration
medical record review; observation of a patient at a meal for change in voice quality, posture, and head control; percentage of meal consumed; eating time; drooling or leakage of liquids and solids; cough during/after a swallow; facial or tongue weakness; palatal movement; difficulty with secretions; pocketing; choking; and a spontaneous dry cough.
Dysphagia screening includes
available such as the Bedside Swallowing Assessment, Burke Dysphagia Screening Test, Acute Stroke Dysphagia Screen, and Standardized Swallowing Assessment
Several validated screening tools for dysphagia are
is an easily administered and reliable tool for health care professionals who are not speech-language pathologists (SLPs)
The Acute Stroke Dysphagia Screen
overall intake is significantly decreased or increased or when one or more nutrients are not ingested, completely digested, or completely absorbed
nutritional problem occurs when
older and younger people and immunosuppressed individuals.
population at greater risk for food poisoning
dysphagia puree, dysphagia mechanically altered, dysphagia advanced, and regular
four levels of diet: (dyspahia)
thin liquids (low viscosity), nectarlike liquids (medium viscosity), honeylike liquids (viscosity of honey), and spoon-thick liquids (viscosity of pudding).
The four levels of liquid include
provides nutrients into the GI tract
Enteral nutrition (EN) // perferred method for person dysphagia
formula via nasogastric, jejunal, or gastric tubes.
Patients with enteral feedings receive
gastric feedings
Patients with a low risk of gastric reflux receive
jejunal feeding is preferred.
pt w/ risk of gastric reflux, which leads to aspiration,
Polymeric (1 to 2 kcal/mL) includes milk-based blenderized foods prepared by hospital dietary staff or in a patient’s home. The polymeric classification also includes commercially prepared whole-nutrient formulas. For this type of formula to be effective, a patient’s GI tract needs to be able to absorb whole nutrients.
enteral formula is usually one of four types.
(3.8 to 4 kcal/mL), consists of single macronutrient (e.g., protein, glucose, polymers, or lipids) preparations and is not nutritionally complete. You can add this type of formula to other foods to meet your patient’s individual nutritional needs.
The second type, modular formulas
(1 to 3 kcal/mL), contains predigested nutrients that are easier for a partially dysfunctional GI tract to absorb.
The third type, elemental formulas
(1 to 2 kcal/mL) are designed to meet specific nutritional needs in certain illnesses (e.g., liver failure, pulmonary disease, or HIV infection).
4th is specialty formulas
are continuous, intermittent via a pump or gravity, and cyclical.
common delivery options for enteral feedings
Usually patients who are more critically ill
receive continuous feedings ( common option enteral feeding)
Patients who are stable or are getting feedings in the home frequently receive
intermittent feedings ( common option enteral feeding)
are used when patients begin to eat a normal diet but still need additional nutritional support
Cyclical feedings ( common option enteral feeding)
insufficient protein intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, and diminished functional status measured by handgrip strength.
clients are considered malnourished if they exhibit two of the following six characteristics:
pneumonia
undernutrition and aspiration, two common complications associated with tube feedings that can lead to
keeping the head of bed elevated at 30 to 45 degrees, reducing the use of sedatives, assessing placement of the enteral access device and tolerance to the enteral feeding every 4 hours, and ensuring adequate bowel function
To reduce the risk for aspiration, nurses follow several practices, such as
Patients diagnosed with pancreatitis, gastric outlet obstruction, gastroparesis, and a history of aspiration are at an increased risk for aspiration with an enteral feeding and may benefit from a small-bore feeding tube placed into the duodenum
increased risk for aspiration if they are diagnosed with these conditions and instead use small-bore feeding
Assess patients for malnutrition by using the
gold standard of indirect calorimetry to estimate protein/energy needs
the risk of aspiration
Administer a prokinetic agent, especially in patients with high gastric residual volumes, as ordered to reduce
coughing, gastroesophageal reflux disease (GERD), cerebral vascular accident (CVA), Parkinson’s disease, nasotracheal suctioning, an artificial airway, decreased level of consciousness, and lying flat
Some of the common conditions that increase the risk of aspiration include
gastric emptying and decrease the risk of aspiration
Prokinetic medications such as metoclopramide, erythromycin, or cisapride promote
250 mL or more remains in a patient’s stomach on two consecutive assessments (1 hour apart) or if a single GRV measurement exceeds 500 mL
Delayed gastric emptying is a concern if
continuous feedings
You need to measure gastric residual volumes (GRVs) every 4 to 6 hours in patients receiving
intermittent feedings
You need to measure gastric residual volumes (GRVs) immediately before the feeding in patients receiving
250 and 500 mL
Reduce risk of aspiration if gastric residual volume of between
(1) stop feedings immediately if aspiration occurs; (2) withhold feedings and reassess patient tolerance to feedings if GRV is over 500 mL; (3) routinely evaluate the patient for aspiration; and (4) use nursing measures to reduce the risk of aspiration if GRV is between 250 and 500 mL
in Critically Ill Patient do the following: (according to The North American Summit on Aspiration in the Critically Ill Patient)
through the nose (nasogastric or nasointestinal), surgically (gastrostomy 1123or jejunostomy), or endoscopically (percutaneous endoscopic gastrostomy or jejunostomy [PEG or PEJ]).
(enteral access tubes) Feeding tubes are inserted through
(e.g., ranitidine, famotidine, nizatidine)
gastric acid inhibitor
(e.g., omeprazole).
proton pump inhibitor
in low serum (extracellular) levels and edema. These changes may cause cardiac dysrhythmias, heart failure, respiratory distress, convulsions, coma, or death.
In refeeding syndrome, potassium, magnesium, and phosphate move intracellularly, resulting
is a form of specialized nutritional support provided intravenously
Parenteral nutrition (PN)
sepsis, head injury, or burns are candidates for PN therapy
Patients in highly stressed physiological states such as (candidates for PN)
a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements. Total
A basic PN formula is
a 2-in-1 formula in which administration of fat emulsions occurs separately from the protein and dextrose solution
PN (TPN), administered through a central line, is
addition of fat emulsion to a PN solution is called a
-pt receives it over 24 hr period
3-in-1 admixture or total nutrient admixture
sudden sharp chest pain, dyspnea, and coughing, cvc placement (PN)
symptoms of a pneumothorax include
fever, chills, or glucose intolerance and has a positive blood culture.
Suspect catheter sepsis if a patient develops
24 hours.
To prevent infection, change the TPN infusion tubing every
24 hours or lipids more than 12 hours.
Do not hang a single container of PN for more than
is the use of specific nutritional therapies to treat an illness, injury, or condition.
Medical nutrition therapy (MNT)
Discourage smoking, alcohol, aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs)
controlling peptic ulcers by
such as celiac disease includes a gluten-free diet
treatment of malabsorption syndromes
wheat, rye, and barley
Gluten is present in
after which patients suffer from malabsorption caused by lack of intestinal surface area.
Short-bowel syndrome results from extensive resection of the bowel,
is a condition that results from an inflammation of diverticula, which are abnormal but common pouchlike herniations that occur in the bowel lining.
Diverticulitis
