Nutrition Flashcards
Estimated Average Requirement
The amount of a nutrient that is estimated to meet the requirement of half of all healthy individuals within a given age or group.
Recommended Dietary Allowance
The average daily dietary intake of a nutrient that is sufficient to meet the nutritional requirements of approximately 98% of healthy people.
Adequate Intake
The amount of a nutrient consumed by a group of healthy people.
Tolerable Upper Intake Level
The maximum daily intake of a nutrient that is likely to be without adverse health effects for almost all individuals
Acceptable Macronutrient Distribution Range
The percentage of protein, fat, and carbs associated with reduced risk of chronic disease, provided there is an intake of other essential nutrients.
Macronutrients VS Micronutrients
Macronutrients - supplies the energy (kilocalories)
Micronutrients - helps manufacture repair and maintain cells
Anabolism VS Catabolism
Anabolism - formation of larger molecules from smaller ones
Catabolism - breakdown of larger molecules into smaller components, releases energy
Carbohydrates
- Supplies energy for muscle and organ function
- Easily digested, fuels strenuous short term skeleton muscle activity and provides most of the energy for the brain
- Glucose is stored in the liver and skeletal muscle tissue as glycogen
- Glycogenolysis: converting glycogen to glucose to meet energy needs
- Spare protein: if glycogen is low, stored protein will be broken down (gluconeogenesis) and lipids for energy.
- Protein being used for energy means they can’t do their primary function of tissue growth, maintenance, and repair.
- Fats are converted directly for fuel through ketones.
- Ketones raise the acidity of blood and can lead to acid-base imbalance.
- Fats are used to fuel people with diabetes because they cannot use glucose for energy
- Carbs enhance glucose secretion, increase feeling of fullness, and improve absorption of sodium and excretion of calcium
Proteins
- Tissue building: structural material for all cells in the body
- Makes up the biggest part of the body after water
- Essential for growth, maintenance, and repair of body cells and tissues
- Nitrogen balance: intake and output of nitrogen is equal
- Positive Nitrogen Balance: nitrogen intake exceeds output, making a pool of amino acids available for growth, pregnancy, and tissue maintenance and repair.
- Negative nitrogen balance: nitrogen intake is lower than nitrogen loss, occurs in illness, injury (ex. burns), and malnutrition
- Complete protein foods contain all essential amino acids necessary for protein synthesis, usually animal sources
- Incomplete protein foods (ex. nuts, grains) don’t provide all essential amino acids unless combined.
- Ex. lentils and rice with yellow peppers make a healthy meal using complementary proteins
- Ex. peanuts with black beans in a salad
- Ex. yogurt with sunflower and flax seeds combines complementary proteins for a vegetarian diet
Lipids
Fats: solid at room temp
Oils: liquid at room temp
- Phospholipids: soluble in water, key component of lipoproteins, major transport vehicles for lipids in the bloodstream
- Organ insulation/protection: provides insulation and protection for vital organs, aids in thermoregulation, aids accurate nurse-impulse transmission
- Component of every cell membrane and are essential to cell metabolism
- Types of lipids: glyceride, sterols, and phospholipids
- Saturated: solid at room temp, usually animal products, dairy products, and lard, can raise LDL (bad) cholesterol levels
- Unsaturated: liquid at room temp, found in plant bases sources, fatty fish, nuts, avocados, can lower LDL and raise HDL
- Essential fatty acids such as Omega-6 (linoleic acid) and Omega-3 (Alpha-linolenic acid) helps protect against heart disease
Vitamins
- Organic substances necessary for metabolism and preventing certian deficiency diseases
- The body cannot make vitamins so they must be ingested
- Critical for building and maintaining body tissues, supporting immune system, and healthy vision
- Helps our body break down and use the energy found in carbs, proteins, and lipids
- vitamins are either water or fat soluble
Minerals
- Inorganic elements found in nature
- Occur in foods naturally or as additives such as supplements
- Macrominerals are needed in 100mg/day or greater
- Trace minerals are essential but in lower concentration
- In the US, calcium is the most common mineral deficiency
Water
- Makes up 55-65% of total body weight in men and 50-55% in women
- Basic solvent for the body’s chemical processes
- Transports oxygen, nutrients, and metabolic waste through the body in the blood
- Fill in the spaces in body tissue to provide body structure and form
- Helps maintain body temp, evaporation of sweat helps cool the body
Basal Metabolic Rate
- Measure of the energy used while at rest in a neutral temp environment
- The energy required for vital organs such as the heart, liver, and brain to function
- Direct measurement of BMR: uses a calorimeter which measures themp changes of water that are produced by exposure to a fasting individual at rest.
- Indirect calculation of DMR: Measures oxygen uptake per unit of time which can be done in an exercise lab or with portable machines at the bedside. Usually done for ICU patients
Factors that affect BMR:
- Body composition: lean body tissue has greater metabolic activity than bone and fat
- Growth periods: BMR increases during periods of growth
- Body temp: BMR increases &% for each 1F (0.83C) rise in body temp
- Environmental temp: cold weather causes a rise in BMR
- Disease process: diseases and injuries involving increased cellular activity result in BMR elevation (cancer, anemia, cardiac failure, hypertension, asthma, etc)
- Prolonged physical exertion
Factors that affect nutrition
- Development stage: nutritional needs vary according to physiological growth, activity level, metabolic processes, disease prevention, etc.
- Dietary patterns
- Work environment
- Cooking methods: Up to half of the water-soluble vitamin content (vitamins B and C) is lost in the cooking water of boiled vegetables. Keeping foods hot longer than 2 hours results in even further loss.
- Oral contraceptive use: Lowers the serum level of vitamin C and several B vitamins. Women with marginal nutrient intake may need vitamin supplements.
- Food to relieve stress
- Tobacco use: Smokers use vitamin C faster than nonsmokers. The more a person smokes the more vitamin C is needed to counteract the damage to cells. Low levels of vitamin C also are linked to iron deficiency. If the person cannot quit smoking, a vitamin C supplement (2,000 mg/day) may help to compensate
- Alcohol: 12oz beer contains 150 calories, juice-based cocktail contains 160 calories. Interferes with adequate nutrition by decreasing appetite, decreasing absorption of nutrients by effecting on intestinal mucosa, impairing storage of nutrients. Alcoholics need multivitamin supplements especially B and folic acid
- Caffeine: Doesn’t effect dehydration, heart disease, cancer, or hypertension. May be associated with bone loss and can be offset with milk. Aids in burning fat for fuel instead of carbs and has been linked with lowering risk of Parkinson’s, type 2 diabetes, stroke, and dementia
- Semi-vegetarians: allow fish, eggs, dairy products, and plant based foods
- Ovo-lacto-vegetarians: allow eggs and dairy products but not fish.
- Lacto-vegetarians: consume only dairy and plant based foods
- Vegans: only plant based foods
- Fruitarians: fruits, nuts, honey, and vegetable oils. Can also intake soybeans, soy milk, tofu and processed protein products
- Eating for health: A diet high in meats and fish, fresh fruits and vegetables, nuts and seeds, eggs, and other natural whole foods is biologically healthier than the modern diet.
- Eating for weight loss
- Ethnic, cultural, religious practices
- Disease processes and functional limitations: chronic disease such as diabetes mellitus and gastrointestinal disorders can alter nutrient
- Medications
- Special diets: regular diets (clients without special needs), NPO (nothing by mouth), diets modified by consistency (patients undergoing surgery, bowel procedures, acute illnesses), chronic health concerns (affect their ability to chew/swallow such as dentition). diets modified for disease
Identifying Nutritional Imbalance
- Complete physical exam: general survey, alterations to vital signs, poor skin turgor, wound healing, concave abdomen/ascites, change in muscle mass
Lab results:
- Blood glucose: levels above normal trigger the release of insulin, levels below trigger release of glucagon
- Serum albumin: synthesized in the liver and constitutes 60% of total body protein. Low levels are associated with malnutrition, malabsorption, acute/chronic liver disease.
- Creatinine: end product of skeletal muscle metabolism, excreted through kidneys, indicates renal function. Increased levels indicate impaired kidney function or loss of muscle mass
- Hemoglobin: low levels indicate inadequate iron intake or chronic blood loss. Globulin forms the backbone of hemoglobin, antibodies, glycoproteins, lipoproteins, clotting factors, and other enzymes. Decreased globulin level indicates insufficient protein intake and excessive protein loss
BMI’s
Overweight: 25.0-29.9
Class 1 Obesity: 30.0-34.9
Class 2 Obesity: 35.0-39.9
Class 3 Obesity: 40.0 or higher
Managing Nutritional Imbalances: Planning
Key Point: must identify the etiology of the imbalance
Examples of etiologies for undernutrition: difficulty chewing/swallowing, alcoholism, metabolic disorders
Examples of etiologies for obesity: overeating, lack of exercise, endocrine problems
Managing Nutritional Imbalances: Interventions
Eduction:
- Teaching client/family the importance of certain vitamins, minerals
- Obtaining nutritious foods on a limited budget
Special clients’ nutritional needs:
- Clients who are NPO
- Older adults: advise to eat nutrient dense foods before dessert
- Nausea/impaired swallowing, impaired digestive function
- Assisting clients with meals: inpatient (delegating feeding to assistive personnel), home care (refer to agency for help obtaining food)
Interventions for obesity:
- Assist with calorie calculations/meal planning
- Encourage exercise/lifestyle changes
- Weigh weekly/suggest food diary
Interventions for undernutrition:
- Encourage client to seek counseling for eating disorders
- Devise strategies to improve appetite
- Enteral nutrition: feedings can be increased/decreased depending on patient’s changing clinical condition
- Parenteral nutrition: monitor tube placement, NG or NE tube insertion site, gastrostomy tube, PEG/PEJ insertion site, fluid balance, weight, tube feeding residual volume, frequency of bowel movements, bowel sounds, abdominal distention, serum electrolyte levels, urine for sugar and acetone, skin turgor, hematocrit and urine specific gravity, and serum blood urea nitrogen (BUN) and sodium levels
Fat Soluble Vitamins
Vitamin A
- Function: night/color vision, cellular growth, maintaining healthy skin and mucous membranes, growth of skeletal and soft tissue, reproduction
- Sources: fish liver oil, liver, butter, cream, egg yolk, yellow fruit, leafy greens, fortified milk
- Deficiency: night blindness, xerosis, xerophthalmia, keratomalacia, skin lesions
- Excess: GI upset, headache, blurred vision, poor muscle coordination, fetal defects
Vitamin D
- Function: regulates blood calcium levels, rate of deposit and resorption of calcium in bone
- Sources: fish liver oil, fish, fortified milk, sunlight exposure
- Deficiency: bone/muscle pain, weakness, fractures, rickets
- Excess: fatigue, weakness, loss of appetite, headache, mental confusion, mental retardation in infants
Vitamin E
- Function: antioxidant, protects RBCs and muscle tissue cells
- Sources: vegetable oils, nuts, milk, eggs, muscle meats, fish, wheat and rice germ, leafy greens
- Deficiency: Hyporeflexia, ataxia, hemolytic anemia, myophathy
- Excess: insufficient blood clotting, impaired immune system
Vitamin K
- Function: synthesis of clotting factors, bone development
- Sources: leafy greens, liver
- Deficiency: increased bleeding
- Excess: jaundice, hemolytic anemia in infants
Macrominerals
Calcium
- Function: bone/teeth formation, blood clotting, nerve conduction, muscle contraction, cellular metabolism, heart action
- Sources: dairy products, sardines, leafy greens, broccoli, whole grains, egg yolks, legumes, nuts, fortified products
- Deficiency: bone loss, tetany, rickets, osteoporosis
- Excess: kidney stones, constipation, intestinal gas
Magnesium
- Function: aids thyroid hormone secretion, maintains normal basal metabolic rate, actives enzymes for carbs and protein metabolism, nerve/muscle function, cardiac function
- Sources: whole grains, nuts, legumes, leafy greens, lima beans, broccoli, squash, potatoes
- Deficiency: tremor, spasm, convulsions, weakness, muscle pain, poor cardiac function
- Excess: weakness, nausea, malaise
Potassium
- Function intracellular fluid control, acid-base balance, nerve transmission, muscle contraction, glycogen formation, protein synthesis, energy metabolism, blood pressure regulation
Sources: unprocessed foods especially fruits, veggies, meats, potatoes, avocados, legumes, link, molasses, shellfish, dates, figs
- Deficiency: muscle weakness, weak pulse, fatigue, abdominal distention
- Excess: cardiac dysrhthmias, cardiac arrest, weakness, abdominal cramps, diarrhea, anxiety, paresthesia
Sodium
- Function: water balance, acid-base balance, muscle action, nerve transmission, convuslions
- Source: table salt, milk, meat, eggs, baking soda/powder, celery, spinach, carrots, beets
- Deficiency: dizziness, adbnormal, cramping, nausea, vomiting, diarrhea, tachycardia, convulsions, coma
- Excess: thirst, fever, dry/sticky tongue and mucous membranes, restlessness, irritability, convulsion
Nutrition Considerations: Nausea
- Apply a cold compress on the back of the neck
- Instruct the patient to wear loose clothing
- Avoid perfumes
- Provide frequent oral hygiene
- Ask patient to sit upright for 30-45 mins after eating.
- Open a window for cool air or turn on a fan
- Apply pressure on the pressure point on the inner wrist approximately 2 1/2 inches down in between two large tendons
- Keep tissues and water to rinse the mouth at the bedside
Nutrition Considerations: Preventing Aspiration
- Monitor level of consciousness, cough and gag reflex, and swallowing ability
- Position the patient upright 90 upright or as far as possible
- Keep suction setup available
- Feed in small amounts
- Cut food into small pieces
- Inspect oral cavity for retained food/medications
- Keep head of bed elevated for 30-45 minutes after feeding
