NUTRITION

o Discuss the six classes of nutrients and importance of each, as well as the adequate
amount and significance of fluids.
o Discuss calculation of body weight standard of BMI and nursing implications.
o Discuss risk factors of poor nutrition (including factors that affect the basal metabolic
rate) and dehydration. Develop strategies for providing nursing care that addresses
nutritional and hydration problems.
o Compare and contrast nutritional changes that occur in the life cycle.
o Discuss the components of a nutritional data collection such as screening tools,
laboratory tests, patient history, and physical assessment.
o Distinguish nutritional and hydration problems and apply appropriate nursing care to
assist patient meeting dietary recommendations.
o Assistance with feeding
o Stimulating appetite
o Use of special/modified diets
o Utilize the MyPyramid Food Guide to evaluate a diet.
o Utilize the nursing process to assist in the development of a plan of care/concept map
to promote nutrition.
o Differentiate the roles of the RN and the LPN in the care of geriatric patients.
o Review Evidence Based Information in text.
o Six Classes of Nutrients
o Nutrients-specific biochemical substances used for body growth, development,
activity, reproduction, lactation, health maintenance, and recovery from illness or
injury

Nutrients that supply energy-essential

1 Carbohydrates (macronutrient)
2 Protein (macronutrient)
3 Lipids or fats (macronutrient)
o Nutrients that regulate body processes-essential
4 Vitamins (micronutrient)
5 Minerals (micronutrient)
6 Water
o Nonessential nutrients-unnecessary for body functioning or already
synthesized in adequate amount (example-excess carbohydrates and protein
converted by body to fat)
o BMR - basal metabolic rate
o Males have a higher BMR due to larger muscle mass
 BMR is about 1 cal/kg of body weight per hour for men
  BMR is about 0.9 cal/kg of body weight per hour for women
o Factors that increase BMR
 Growth, infections, fever, emotional tension, extreme environmental
temperatures, elevated levels of certain hormones
 Fasting/very low calorie diet-body interprets this eating patter as
starvation and compensates by slowing down the resting metabolic
rate, making it more difficult to lose weight.
o Factors that decrease BMR
 Aging, prolonged fasting, and sleep

Body Weight Standards

o If energy expenditure does not equal energy intake weight will fluctuate
o Ideal Body Weight=healthy body weight
o Body Mass Index (BMI) used to establish ideal body weight and disease risk
o Not accurate with athletes (large muscle mass), people with
edema/dehydration, older people (less muscle mass)
o Percent body weight change
usual body weight-current body weight
 ×100
usual body weight

Caloric Requirements
o 1 pound body fat = about 3,500 calories
o To gain or lose 1 lb. (0.45 kg) in a week, it is necessary to increase or decrease,
respectively, daily calorie intake by 500 calories
o 3,500calories ÷ 7 days=500 calories /day
o Decreased BMR leads to decreased need for energy thus decreased need for
calories
o Increased activity leads to increased caloric need

Energy Nutrient
o Carbohydrates
o Protein
o Fats
o KNOW-nutrient, potential food sources, function in body and significance

Carbohydrates
o Sugars and starches
o Organic compounds composed of carbon, hydrogen, and oxygen
o Serve as the structural framework of plants; lactose is only animal source
o Most abundant and least expensive source of calories in the world
o Classified as simple or complex sugars
o 90% of carbohydrate intake is ingested
o Converted to glucose for transport through the blood
o Cells oxidize glucose to provide energy, carbon dioxide, and water
 o 50 to 100 g of carbohydrates are needed daily to prevent ketosis
o Low carbohydrate intake can cause ketosis, high intake can increase risk for
dental caries
Protein
o Required for the formation of all body structures
o Labeled complete (high quality) or incomplete (low quality), based on amino
acid composition
o Animal proteins are complete; plant proteins are incomplete
o Protein tissues are in a constant state of flux
o RDA for adults is 0.8 g/kg of body weight, 10% to 20% total calorie intake
o Function in tissue growth and repair, component of body framework,
component of body fluids, part of fluid balance, part of acid base balance,
detoxifies harmful substances, forms antibodies, transporter in blood, provides
energy when carb intake inadequate.

Fats
o Insoluble in water and blood
o Composed of carbon, hydrogen, and oxygen
o 95% of lipids in diet are triglycerides
o Contain mixtures of saturated (raise cholesterol levels) and unsaturated (lower
cholesterol levels) fatty acids
 Most animal fats are saturated
 Most vegetable fats are unsaturated
o Digestion occurs largely in the small intestine
o Most concentrated source of energy in the diet
o RDA not established, should be no more than 20% to 35% total calorie intake

Vitamins
o Organic compounds needed by the body in small amounts
o Most are active in the form of coenzymes
o Needed for metabolism of carbohydrates, protein, and fat
o Classified as water soluble or fat soluble
 Water soluble(C & B complex)-usually not stored in body, deficiency
can develop quickly, daily intake needed
 Fat soluble (A, D, E, K)-body stores excess, daily intake not needed,
deficiencies usually secondary to fat digestion & absorption altered
o Absorbed through the intestinal wall directly into bloodstream
Vitamins
o Vitamin C
o Vitamin B6 (pyridoxine)
o Vitamin B12 (cyanocobalamin)
 Source-citrus fruits, broccoli, green pepper, strawberries, greens
o Function-collagen formation antioxidant, enhances iron absorption
o Signs & symptoms of deficiency-scurvy, hemorrhaging, delayed wound healing
o Signs & symptoms of excess- hot flashes, headache, nausea, diarrhea
Source-yeast, banana, cantaloupe, broccoli, spinach
o Function-coenzyme in protein, fat, carbohydrate metabolism
o Signs & symptoms of deficiency-microcytic anemia, CNS problems
o Signs & symptoms of excess- difficulty walking, numbness of feet and hands

Source-animal products: organ meats, seafood

o Function-coenzyme in protein metabolism and formation of heme portion of
hemoglobin
o Signs & symptoms of deficiency-pernicious anemia (B 12 deficiency related to
impaired absorption due to lack of intrinsic factor)
o Signs & symptoms of excess-none known

Vitamins continued
o Folate
o Vitamin A (fat soluble)
o Vitamin D (fat soluble)

Source-green leafy vegetables, liver

o Function-RNA and DNA synthesis formation and maturation of RBC
o Signs & symptoms of deficiency-macrocytic anemia, fatigue, weakness, pallor
o Signs & symptoms of excess-none known

Source-liver, carrots, egg yolk, fortified milk

o Function-visual acuity in dim light, formation an maintenance of skin and
mucous membranes; immune function
o Signs & symptoms of deficiency-night blindness, rough skin, bone growth
ceases
o Signs & symptoms of excess- anorexia, loss of hair, dry skin bone pain, vomiting,
birth defects during pregnancy

Source-sunlight, fortified milk, fish liver oils

o Function-calcium and phosphorus metabolism, stimulates calcium absorption
o Signs & symptoms of deficiency-retarded bone growth, bone malformation
o Signs & symptoms of excess-excessive calcification of bones, renal calculi,
nausea, headache

Minerals
o Organic elements found in all body fluids and tissues
 o Some function to provide structure in body, others help regulate body processes
o Contained in the ash that remains after digestion
o Macrominerals include calcium, phosphorus, and magnesium
 Calcium
 Sodium
 Potassium
o Microminerals include iron, zinc, manganese, and iodine
 Iron

Minerals (macrominerals)
o Calcium
o Phosphorus
o Magnesium

Source-milk, dairy products, canned fish with bones, greens

o Function-bone and tooth formation, blood clotting, nerve transmission, muscle
contraction
o Signs & symptoms of deficiency-tetany, osteoporosis
o Signs & symptoms of excess-
o Renal calculi in susceptible people

Source-milk, dairy products, soft drinks, processed foods

o Function-bone and tooth formation, acid-base balance, energy metabolism
o Signs & symptoms of deficiency-hypophosphatemia: anorexia, muscle
weakness
o Signs & symptoms of excess- hyperphosphatemia: symptoms of hypocalcemia
tetany

Source-green leafy vegetables, nuts, beans, grains

o Function-bone and tooth formation, protein synthesis, carbohydrate
metabolism
o Signs & symptoms of deficiency-hypomagnesemia: weakness, muscle pain,
poor heart function
o Signs & symptoms of excess-hypermagnesemia: CNS depression , coma,
hypotension

Minerals continued
o Sodium
o Potassium
o Chloride

Source-salt, processed food

 o Function-major ion of extracellular fluid, fluid balance, acid-base balance
o Signs & symptoms of deficiency-hyponatremia: muscle cramps, cold and
clammy skin
o Signs & symptoms of excess-edema, weight gain, high blood pressure if
susceptible

Source-whole grains, fruits, leafy vegetables

o Function-major ion of intracellular fluid, fluid balance, acid-base balance
o Signs & symptoms of deficiency-hypokalemia: muscle cramps and weakness,
irregular heartbeat
o Signs & symptoms of excess-hyperkalemia: irritability, anxiety, cardiac
arrhythmia, heart block

Source-salt
o Function-component of HCl in stomach, fluid balance, acid-base balance
o Signs & symptoms of deficiency-hypochloremia: muscle spasms, alkalosis,
depressed respirations
o Signs & symptoms of excess-hyperchloremia-acidosis

Minerals continued (microminerals)

o Iron
o Iodine
o Fluoride

Source-liver, lean meats, enriched and whole grain breads

o Function-oxygen transport by way of hemoglobin, constituent of enzyme
systems
o Signs & symptoms of deficiency-microcytic anemia, pallor, decreased work
capacity, fatigue, weakness
o Signs & symptoms of excess-hemosiderosis; acute iron poisoning from
accidental overdose leads to GI symptoms and possible shock

Source-iodized salt, seafood, food additives

o Function-component of thyroid hormones
o Signs & symptoms of deficiency-goiter
o Signs & symptoms of excess-acne like lesions

Source-fluoridated water, fish, tea

o Function-tooth formation an integrity, bone formation and integrity
o Signs & symptoms of deficiency-tooth decay; may increase risk for osteoporosis
o Signs & symptoms of excess-mottling and discoloration of tooth enamel
Water
o Accounts for between 50% and 60% of adult’s total weight
o Two-thirds of body water is contained within the cells (ICF)
o Remainder of body water is ECF, body fluids (plasma, interstitial fluid)
o Provides fluid medium necessary for all chemical reactions in body
o Acts as a solvent and aids digestion, absorption, circulation, and excretion
o 2,200-3000 mL per day recommended for adults
Adequate Diet Selection
o Balanced intake of all essential nutrients in appropriate amounts
o Dietary Recommendations
o Dietary Guidelines for Americas

Summary in text
o Dietary Reference Intakes (DRI)
o Guidelines for individuals
o Recommended Dietary Allowance (RDA)
o Adequate Intake (AI)
o Tolerable Upper Intake Level (UL)
o Guidelines for groups and populations
o Estimated Average Requirement (EAR)
o MyPlate Food Guide
(My Pyramid)
o Based on 2012 Dietary Guidelines
o Designed to remind Americans to eat healthy
o 5 food groups in a plate setting
o Eat a variety of foods from all food groups and remain physically active every day.
 Goals
 Enjoy food, but eat less
 Balance calories & avoid overeating
 Increase intake of vitamins, minerals, and dietary fiber
 Reduce sodium
 Drink water not sugary drinks
 EXERCISE
 Food Labeling
 Nutritional Labeling and Education Act
 Labels to include
 Nutrition labeling
 Serving size
 Descriptors
 Health claims
 Amount of trans fat
 Amount of saturated fat
  Cholesterol
 Dietary fiber
 Factors affecting Food Habits
 Physiologic and physical factors
 Stage of development, state of health, medications
 With food allergies-avoid allergens
 Physical, sociocultural, and psychosocial factors influencing food choices
 Economics, culture, religion, tradition, education, politics, social
status, meaning of food, food ideology
 Developmental Considerations
 Growth—infancy, adolescence, pregnancy, and lactation increase nutritional
needs
 Activity increases nutritional needs
 Age-related changes in metabolism and body composition
 Nutritional needs level off in adulthood
 Fewer calories required in adulthood because of decrease in BMR
 Older adults-
 Decrease BMR and activity, loss of body mass, energy expenditure
decreases
 Loss of teeth/periodontal disease
 Decrease peristalsis & constipation
 Taste sensation changes
 Thirst sensation decreases
 More degenerative disease and more medications
 Social-isolation, self-esteem, loss of independence can impact
nutrition
 Other factors
 Risk Factors for Poor Nutritional Status
 Food Intake
 Decreased food intake
 anorexia
 Increased food intake
 obesity
 Nutritional Assessment Considerations for Older Adults
 Biochemical Data
 Albumin synthesis declines with age
 Anemia is common
 Anthropometric Data-related to the physical measurements of the human body,
such as height, weight, body circumferences and percentage of body fat
 Dietary Data
 https://www.choosemyplate.gov/older-adults
 Therapeutic Diets
 Diabetic diet-consistent carbohydrate diet
  Fat restricted diet
 High fiber high fiber foods
 Low fiber low fiber foods
 Sodium restricted
 Renal diet
 Vegetarian
 Normal/house diet
 Modified consistencies
 NPO
 Liquid diet
 Clear liquid
 Full liquid
 Pureed & Mechanically altered
 https://www.slideshare.net/kmbrlyslp/kimberly-jones-dysphagia-diets-
presentation-10138013
 Water and thickened liquids
 People who have difficulty swallowing thin liquids often must drink thickened
liquids. Drinking thickened liquids can help prevent choking and stop fluid from
entering the lungs.
 When orders ALL liquids are thickened including water and coffee!
 3 consistencies
 Nectar
 Honey
 Pudding
http://www.wrha.mb.ca/extranet/nutrition/files/ClientEd_Texture_ThickFluids%20-
%20Disclaimer.pdf
 Enteral Nutrition
 Short term-NGT, Long term-gastrostomy or PEG; verify placement
 X ray
 Check pH
 Check residual-placement check & to assure absorption
 Pain/nausia
 Abdominal distention
 Regurgitation
 Large volume of residual
 Length of tube
 Air bolus considered ‘old technique’
 Carbon dioxide monitor
 NGT vs PEG
 Enteral Feeding
 Feeding schedule
 Continuous
 Intermittent
  Dumping syndrome
 Cyclic
 Formulas-many types, determined by patient needs
 Nutritionally balanced
 Contain fiber, protein, and high in calories
 Want to get to full strength to meet nutritional needs
Make sure patient is UPRIGHT, avoid formula contamination
Monitor for complications
Provide comfort-frequent oral care, keep nares clean, protect tube & prevent patient
injury
Promoting safety with enteral feeding
Verify placement, every time a feeding starts, medications, regular intervals, any
time potential displacement
Check gastric residual
 High residual, high risk for aspiration
 Abdominal distention? Abdominal discomfort? Nausea & vomiting?
Sterile water flushes with immunocompromised or critically ill
Facility guidelines for withholding feeding
Assess the abdomen for abnormality-bowel sounds checked once a shift;
distention, girth, bloating, pain
Keep them upright-HOB up
Prevent contamination
Proper medication administration
Stimulating the appetite
Small frequent meals
Solicit food preference
Encourage-make it pleasant not a task
Make it LOOK good
Schedule meds so not to interfere
Control pain, nausea, depression
Offer alternatives when not eating
 Provide oral hygiene & make resident comfortable
Keep eating area clean, attractive, odor free and free of clutter
Keep food in reach
Continue previous rituals
Re heat if meal time disturbed for some reason
Do not disturb mealtime unless absolutely necessary
See special circumstances-Focus on the Older Adult p. 1221
Meal Time Care and Feeding
To ready the resident
 Incontinence care, Take to bathroom or offer bedpan prior to
meal
  Wash hands and face
 Position comfortably and safely
Tray set up
 Greet by name, indicate meal to be served, Sit if feeding
 Use clothing protector if appropriate(NOT called a bib!) and ask if
OK to apply
 Place tray in front of resident, remove plastic wraps, covers,
open cartons
 Open condiments and apply as resident desires
 Cut up food in bite size pieces, butter bread, fix potatoes,
sweeten tea, fix coffee
 Straw (NOT with thickened liquids, eating utensils in reach
 Check for further needs before leaving if resident feeds self
 If feeding-Feed at the resident’s pace-usually slow, rotate foods &
solicit resident preference
See also Box 35-7 Special considerations and interventions for feeding patients with
dementia or other alterations in cognitions AND Box 35-8 Special considerations
and interventions for feeding patients with dysphagia
 Parenteral nutrition
 Total Parenteral Nutrition (TPN)-Nutrition provided entirely through
intravenous route through a central line
 Peripheral Parenteral Nutrition (PPN)- Less concentrated, meant for short term
 Nurse monitors
 Complications
 Infection
 Blood sugar
 Sepsis
 Nutrition and the Nursing Process Assessment
 Assessment-simple screening, history taking (dietary, medical, socioeconomic)
 Physical assessment (include BMI)
 Biochemical data
 Anthropometric data-indirect measurements of body protein and fat
stores
 Dietary data
 Dietary recall
 Mini nutritional assessment (MNA) https://consultgeri.org/try-
this/general-assessment/issue-9.pdf
 24 hour recall
 Food diaries/calorie count
 Food frequency record
 Diet history
 Observations for Nutritional Assessment
 Nutrition and the Nursing Process
Diagnosing
 Imbalance Nutrition
 More than body requires
 Less than body requires
 Risk for
 Ineffective Health Maintenance
 Constipation
 Deficient Fluid Volume
 Risk for Infection
 Impaired Home Maintenance
 Expected Outcomes-to maintain or restore optimal nutritional status
 Nutrition and the Nursing Process
Implementing
 Provide proper & adequate nutrition while following MD orders
 Teach nutritional information
 Monitor nutritional status
 Stimulate the appetite
 Assist with eating
 Provide oral nutrition and or enteral nutrition
 Nutrition and the Nursing Process
Evaluating
 Evaluate progress toward outcomes
 Evaluate tolerance and adherence to diet
 Assess level of understanding
 Communicate findings
 Revise where needed
 Activities
 Track and Field https://www.choosemyplate.gov/games
 Nutrition Trivia