NURS 171: Week 10 Nutrition Flashcards
My Plate
-U.S.D.A. guidelines for Americans visually illustrates a healthy meal
Suggestions for:
>variety
>portion size
>activity
>tools for successful nutritional lifestyle
Nutrition Facts Label
Labeling Required
- includes serving size, number of servings per package, total calories and calories from fat per serving
- contains a list of key nutrients present
- lists the percent daily values
Macro-nutrients
supply body with energy
- carbohydrates
- proteins
- lipids
Micro-nutrients
help manufacture, repair, and maintain cells through metabolism
- vitamins
- minerals
- water
Metabolism
-body changes and uses nutrients for vital processes and bodily functions
-most triggered by enzymes
ex:
>anabolism (requires energy– building up)
>catabolism (releases energy– breaking down)
Carbohydrates
Macro-nutrient
-primary energy source for body
-enhance insulin secretion
-increase a sense of fullness + satisfaction
>simple carbohydrate
>complex carbohydrate
-glucose stored as glycogen in liver + muscle tissue as glycogen
Simple Carbohydrate
- easily + quickly digested
- supply energy
Examples of Simple Carbohydrates
- corn syrup
- milk
- honey
- table sugar
- molasses
- sugar cane
- sugar beets
- fruits
Complex Carbohydrates
- fiber
- not digestible by humans
- provides no usable glucose
- aids in passage of bowel movements
Examples of Complex Carbohydrates
- vegetables
- breads
- cereals
- pasta
- grains
- legumes
Glycogenolysis
converts stored carbohydrates back to glucose for energy when needed
Gluconeogensis
body converts stored protein and lipids (fats) to use for energy (ketones)
Ketones
an alternative fuel when glucose is not available
Proteins
-made up of amino acids
-responsible for tissue growth, maintenance, and repair
-metabolism
-immune system function
-regulates fluid + acid-base balance
-secondary energy source
Needs Vary On:
>age
>sex
>weight
>health
Amino Acids
- building blocks of most proteins
- protein synthesis requires all required amino acids to be present
Essential Amino Acids
- can not be synthesized by the body
- obtained through diet
Non-Essential Amino Acids
-can be synthesized by the body
Complete Protein
foods that contain all essential amino acids for protein synthesis (usually from animal sources)
Incomplete Protein
-do not provide all of the essential amino acids
-non animal sources (nuts/grains)
-combined with another incomplete protein can make a complete protein
(Ex: peanut butter on whole rain roll)- important in vegetarian diet
Digestion of Proteins
- begins in stomach
- occurs mostly in small intestine
- enzymes break down protein into amino acids
- nitrogen balance occurs when intake + output of nitrogen (protein) are equal
Functions of Dietary Protein
- tissue building
- metabolism
- immune system function
- fluid balance
- acid-base balance
- secondary energy source
Protein: Tissue Building
growth, maintenance, and repair of body cells and tissues
Protein: Metabolism
- protein are precursors to digestive enzymes + hormones
- combine with iron to form hemoglobin
Protein: Immune System Function
- Lymphocytes (WBC) are proteins
- Antibodies are proteins
Proteins: Regulate Fluids + Acid Base Balance
proteins help regulate fluid + acid base balance
Protein: Secondary Energy Source
when carbohydrate stores are low, protein can be broken down for energy
Lipids
- insoluble in water
- Fats solid at room temperature
- Oils liquid at room temperature
- essential nutrient for brain + nerve function
- metabolism occurs in small intestine
- stored in adipose tissue fat
Function of Lipids
- supply essential nutrients
- energy source
- flavor + satiety
- cholesterol function
- insulation
- protects vital organs
- component of every cell membrane
- essential to cell metabolism
- enables accurate nerve impulse transmission
- thermoregulation
Function of Lipids: Supply Essential Nutrients
- food fats supply essential fatty acids
- aid in absorption of fat soluble vitamins
Function of Lipids: Energy Source
body burns fat for energy as needed
Function of Lipids: Flavor + Satiety
- lipids give food cream taste and texture
- makes us feel “full”
Function of Lipids: Cholesterol Function
- part of every cell in body
- in bile: helps digest fats
- serves as a precursor to all steroid hormones
- can contribute to atherosclerosis
Types + Sources of Lipids
- Glycerides
- Sterols
- Phospholipids
Lipids: Glycerides
Triglycerides–> main glyceride found in food
Lipids: Sterols
-Cholesterols: found in animal proteins, synthesized in liver
>needed for formation of cell membranes, vitamin D, estrogen + testosterone
Lipids: Phospholipids
-key component in lipoproteins
-major transport for lipids to cells in the bloodstream
>Low Density Lipoproteins (LDL)
>High Density Lipoproteins (HDL)
Low Density Lipoproteins
(LDL)
transports cholesterol to body cells
High Density Lipoproteins
(HDL)
removes cholesterol from bloodstream, return to liver to produce bile
Essential Fatty Acids
-body can not manufacture it
>essential acids help protect against heart disease (omega 3 + 6)
>absence of essential acids creates a deficiency disease
Why is water an Essential Nutrient?
- makes up large percentage of body weight
- where chemical processes take place
- transports substances (oxygen, nutrients, metabolic waste)
- maintain body temperature
- fluid balance–> intake = output
- lubricates joints
- intake needs 2-3 liters/ day
BMR
Basal Metabolic Rate
-amount of energy required at rest for major organs to function (heart, liver, brain)
Direct Measurement for Basal Metabolic Rate (BMR)?
calorimeter
Indirect Measurement for Basal Metabolic Rate (BMR)?
- bedside measuring oxygen uptake per unit of time
- serum thyroxine levels (blood test)
- formula
Factors that Affect BMR
-body composition
-growth periods
-body temp
-environmental temp
-disease processes
-prolonged physical exertion
Total Energy Needs:
>replacing calories used for BMR + physical activity
>age, weight, type of activity
Factors That Affect Nutrition: Developmental Stage
- physical growth
- activity level
- metabolic processes
- disease prevention
What Factors Affect Nutrition In Adults?
- require adequate amounts of protein, vitamins, + minerals
- calcium, vitamin D, folic acid, + iron are critical (especially in women for bone + reproductive health)
- women of childbearing age should take folic acid supplement to decrease risk of neural tube defects in fetus
- BMR decrease–> may gain weight
- chronic diseases begin to occur related to heredity or poor lifestyle choices
Factors That Affect Nutrition In Older Adults
- need less calories but same nutrients; may need supplements
- lose interest in eating
- physical changes may include decreased thirst sensation, decreased taste + smell
- decreased vision + hearing may limit mobility and interacting interfering with shopping and food preparation
- tooth loss + gum disease limit chewing
- physical problems (decreased intestinal peristalsis, gastrointestinal reflex disease)
- may need therapeutic diet
Factors That Affect Nutrition: Lifestyle Choices
- dietary patterns
- cooking methods
- oral contraceptives
- using food to cope
- tobacco use
- alcohol
- caffeine
Factors That Affect Nutrition: Vegetarianism
- diets that exclude meat + poultry
- vary other limitations of food (fish, dairy)
- protein, vitamin, and mineral deprived
- consult nutrition professional especially during periods of growth, breastfeeding, pregnancy, or recovery from illness
- choose this diet in hopes of reducing risk of disease + promote wellness
Eating For Health
- avoid processed foods, grains, + beverages
- avoid trans-fats, preservatives + chemical additives
- consume diet of meats, fish, fresh fruits, vegetables, nuts, seeds, + eggs
Eating For Weight Loss
- calorie restriction diet
- behavior modification
- variety of food choices + a balance of nutrients
- encourage physical activity, sleep, reduced stress
Overweight/ Obesity
consuming nutrients
- in excess of metabolic demands
- more than needed for activity, gender, height, weight
- calculate BMI
- Overweight = BMI >25 but <29.9
- Obese = BMI >30
Special Diets
-regular
-NPO
-diets modified by consistency:
>clear liquids
>full liquids
>mechanical soft diet
>pureed
-diets modified by disease
Dietary History
- 24 hour recall
- food frequency questionnaire
- food record (most accurate)
Anthropometric Measurements
- measures the body composition (proportion of fat in the body)
- noninvasive physical examination techniques to determine body dimensions
- height + weight
- assess growth rate in children
- indirectly assesses adult protein + fat stores
- assess overweight, obesity + underweight
Assessing Body Composition
Anthropometric Measurements -circumference measurements of >arm, abdomen, waist to hip ratio -BMI >roughly estimated by using a calculation formula, table or calculator
BMI
-normal range = 18.5- 24.9
-identify underweight + overweight
-varies for athlete, pregnant + postpartum women
>underweight= <18.5
>healthy= 18.5- 24.9
>pre-obese= 25.0- 29.9
>obese= >30
Physical Assessment Findings for Nutritional Imbalance
- alterations in vital signs (include quality of pulse)
- height, weight, BMI
- poor skin turgor, poor wound healing
- health of hair, nails, lip, tongue, teeth, gums, eyes
- concave abdomen, ascites, bowel sounds
- change in muscle mass, edema
- changes in blood glucose, albumin, BUN, hemoglobin
Lab Values that Indicate Nutritional Status
-blood glucose >hyperglycemia >hypoglycemia -albumin -prealbumin -transferrin -urea (BUN) -creatinine
Lab Values Indicate Nutritional Status: Blood Glucose
amount of fuel available for cellular energy
Lab Values Indicate Nutritional Status: Hyperglycemia
in non-diabetics, blood sugar above normal level triggers release of insulin which causes the glucose to move into the body cells and be stored in liver + muscles
Lab Values Indicate Nutritional Status: Hypoglycemia
blood sugar falling below normal triggers release of glucagon, leading to the release of glucose from storage
Lab Values Indicate Nutritional Status: Albumin
- low levels associated with malnutrition, malabsorption, liver disease, loss of protein from other sources (Burns)
- affected by fluid status
Lab Values Indicate Nutritional Status: Pre-Albumin
acute changes (in nutrition)
Lab Values Indicate Nutritional Status: Transferrin
- protein that binds with iron
- measures protein depletion, iron deficiency
Lab Values Indicate Nutritional Status: Urea (BUN)
- elevations seen with impaired kidney function, dehydration, excessive protein breakdown or intake
- low BUN seen with low protein intake
Lab Values Indicate Nutritional Status: Creatinine
- end production of skeletal muscle metabolism
- increased levels may indicate impaired kidney function + loss of muscle mass
Impaired Swallowing
(dysphagia) -at risk for choking + aspiration Caused by: >mechanical obstruction (tumor) >neuromuscular impairment (stroke, cerebral palsy) >anatomical or physiological defect
Impaired Swallowing Interventions
- provide/ use assistive devices
- avoid use of straws
- tuck chin in preparation for swallowing
- place food at back of mouth, on unaffected side
- check mouth for pocketing of food
- monitor body weight + hydration status
- position upright (90 degrees) or as far as possible
- keep HOB elevated 30 to 45 degrees after eating
- have suction available
- feed small amounts
- use thickening agent
Assisting With Meals
- if condition allows, encourage to get out of bed and eat meals in dining room
- assess rituals before meals (blessings)
- provide toileting, oral hygiene + hand washing before meals
- encourage independence
- provide adequate time for chewing + swallowing
Assisting With Meals With Patients With Dementia
- assess cognitive limitations + communication abilities
- minimize distractions
- cue patient verbally, “take a bite”, “chew”, and “swallow”
- guide hand
- involve family members
- give client time to eat independently
- do not feed too fast
Parenteral Nutrition
- intravenous nutrition
- administered over a 24 hour period
Enteral Nutrition
(tube feeding)
-delivery of liquid nutrition (at room temp) into upper intestinal tract via a tube
-in addition to feeding or instead of oral intake
-preferred method for patient who needs nutritional support, who has functional GI tract
>trauma, burns, severe malnutrition, neurological disorders that affect swallowing, anorexia nervosa, prematurity, failure to thrive
Risk Associated With Enteral Feedings
> aspiration into lungs
-can lead to infection, pneumonia, abscess formation, adult respiratory distress syndrome (ARDS), death
source of bacterial growth
-check expiration date
diarrhea, nausea + vomiting, nasopharyngeal trauma
alteration in drug absorption + metabolism
Reason For Enteric Tubes
- administer liquid nutrition
- instead of or in addition to oral intake
- lavage of the stomach (irrigation/ washing out, drainage of stomach contents)
- collecting a specimen of stomach contents
- prevent nausea, vomiting + gastric distention postoperatively
Selecting a Feeding Tube: Different kinds
- Nasogastric (NG tube)
- Feeding Nasogastric Feeding Tube
- Oropharyngeal Tube
- Nasoenteric Tube (NE)
- Gastrostomy Tube (G tube)
Nasogastric (NG) Tube
- for short term use (< 6 weeks)
- for feeding or drainage of stomach contents
Feeding Nasogastric Feeding Tube
inserted through one naris, passed through the nasopharynx into the esophagus then into the stomach
Oropharyngeal Tube
inserted through the mouth, may trigger gagging or unconscious chewing on the tube
Nasoenteric (NE) Tube
- longer than NG tube, extended down into the duodenum or jejunum
- for patients at risk for aspiration (decreased level of consciousness, absent or diminished gag reflex, or severe gastroesophageal reflux)
Gastrostomy (G) Tube
- long term feeding tube
- placed surgically or endoscopically through the skin and the abdominal wall into the stomach or jejunum
Administering Enteral Feedings: Feeding Schedules
- continuous
- cyclic
- intermittent “closed”
- intermittent bolus “open”
Feeding Schedule: Continuous
Ex: 50 mL/hour for 24 hours
- debilitated to patients who require intensive nutritional support
- constant flow
- feeding interrupted for installation of medication and flushing with water
- pump recommended
Feeding Schedule: Cyclic
- infusion time less than 24 hours per day
- some feedings only given at night
- some patients may “eat” during the day
Feeding Schedule: Intermittent Bolus Feedings “open system”
- uses a syringe or bag to deliver formula over a 5 to 10 minute period into gastric tube
- easy to teach family members
- frees patient from mechanical devices that limit activity
- increases risk of respiration aspiration + stomach distention
- exposed to environment; risk of contamination
Feeding Schedule: Intermittent “closed” system (bag or bottle)
-prefilled system
-supplement oral intake or
-for patients who want greater mobility
-given on regular basis for 30 to 60 minutes
Ex: “give 250 mL of enteral nutrition very 4 to 6 hours”
-may be given with pump; has drip chamber
-decrease risk of contamination
-functions like IV fluid–> nurse spikes
Preventing Contamination of Enteral Feedings
- check expiration date
- label container with date + time
- use hand hygiene, non sterile gloves
- tubing + supplies are sterile when opened; handle with care
- replace equipment per policy
- keep unopened solutions at room temp
- never allow feeding to hang below level of stomach
Parenteral Nutrition Solutions
- contain 20% concentration of dextrose in water, along with amino acids, vitamins, minerals, + trace elements
- calories depend on patients energy need
- solutions standardized or individualized to meet patients needs
- delivered through a large, high-flow vein through a central venous access catheter (subclavian vein)
Parenteral Nutrition: Lipid Emulsions
- contain essential fatty acids, triglycerides, and supplemental calories
- administered to prevent essential fatty acid deficiency
- lipids may be administered at the same time as parenteral nutrition through a peripheral line or by a connected tubing through the central line
Monitor + Maintenance For Patients Receiving Parenteral Nutrition
- assess catheter insertion site + dressing
- monitor tube connections
- check rate + amount infused
- regularly weigh patient per policy
- check glucose level of patient per policy
- monitor intake + output
- check lab values: albumin, transferrin, prealbumin, CBC, liver function, BUN
- do not use PN infusion line for administering other meds or solutions
