Chapter 25 nutrition lecure and slide notes PDF

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Chapter 45 nutrition Scientific Knowledge base  Nutrients: The Biochemical Units of Nutrition  Basal metabolic rate (BMR)  Energy needed at rest to maintain life-sustaining activities for a specific amount of time  Resting energy expenditure (REE)  Amount of energy needed to consume over 24-hour period for the body to maintain internal working activities while at rest  Nutrients  Energy necessary for the normal function of numerous body processes  Digestion  Mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form  Absorption  The small intestine, lined with fingerlike projections called villi, is the primary absorption site for nutrients.  The body absorbs nutrients by means of passive diffusion, osmosis, active transport, and pinocytosis.  Absorption of carbohydrates, protein, minerals, and water-soluble vitamins occurs in the small intestine.  Metabolism and Storage of Nutrients  Metabolism o All biochemical reactions within the cells of the body  Anabolism o Building of more complex biochemical substances by synthesis of nutrients  Catabolism o Breakdown of biochemical substances into simpler substances; occurs during physiological states of negative nitrogen balance  Elimination  Chyme moves by peristaltic action through the ileocecal valve into the large intestine, where it becomes feces.  Water absorbs in the mucosa as feces move toward the rectum.  Dietary Guideline  Dietary reference intakes (DRIs) o Acceptable range of quantities of vitamins and minerals for each gender and age group  Food guidelines  Daily values o Needed protein, vitamins, fats, cholesterol, carbohydrates, fiber, sodium, and potassium B. Nursing Knowledge Base  Factors influencing nutrition  Environmental factors  Developmental needs

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Infants through school age o Breastfeeding, formula, solid foods  Adolescents  Young and middle adults  Older adults  Alternative Food Patterns  Based on religion, cultural background, ethics, health beliefs, and preference  Vegetarian diet consists predominantly of plant foods:  Ovolactovegetarian (avoids meat, fish, and poultry, but eats eggs and milk)  Lactovegetarian (drinks milk but avoids eggs)  Vegan (consumes only plant foods)  Zen macrobiotic  Fruitarian (consumes fruit, nuts, honey, and olive oil) Critical Thinking  Synthesis of knowledge, experience, information  Apply professional standards  DRIs  USDA MyPlate dietary guidelines  Healthy People 2020  American Heart Association  American Diabetes Association  American Cancer Society  American Society for Parenteral and Enteral Nutrition Nursing Process  Assessment  Through the patient’s eye  Assess patient’s nutritional history.  Ask patient about food preferences, values regarding nutrition, and expectations from nutritional therapy.  Screening  Anthropometry is a measurement system of the size and makeup of the body.  An ideal body weight (IBW) provides an estimate of what a person should weigh.  Body mass index (BMI) measures weight corrected for height and serves as an alternative to traditional height–weight relationships.  Laboratory and biochemical tests.  Dietary and health history  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  Physical examination  Dysphagia (difficulty swallowing)  Planning  Goals and outcomes  Reflect a patient’s physiological, therapeutic, and individualized needs 

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 Setting priorities  Teamwork and collaboration  Discharge planning  Enteral tube feedings  Implementation  Health promotion  Education  Early identification of potential or actual problems  Meal planning  Weight loss plans  Food safety  Acute care  Risk factors in acutely ill patient  Advancing diets = Gradual progression of dietary intake or therapeutic diet to manage illness  Promoting appetite  Assisting with oral feedings  Therapeutic Diets  Clear Liquid  Full Liquid  Dysphagia  Mechanical soft  Sodium, Cardiac, Fiber, Diabetic  Regular  Enteral Tube Feeding  Enteral nutrition (EN): provides nutrients into the GI tract. It is physiological, safe, and economical nutritional support.  Nasogastric, jejunal, or gastric tubes  Surgical or endoscopic placement o Nasointestinal o Gastrostomy o Jejunostomy o PEG (percutaneous endoscopic gastrostomy) o PEJ (percutaneous endoscopic jejunostomy)  Risk of aspiration  Enteral Access Tubes o When patients are unable to ingest food but are still able to digest and absorb nutrients, the use of enteral tube feeding is supported  Nutritional management o Insert feeding tube as ordered. o Initiate enteral feeding as prescribed. o Advance tube feeding as tolerated; monitor for tolerance.  Aspiration precautions o Position head of bed elevated a minimum of 30 degrees. o Check tube placement every 4 to 6 hours. o Check gastric residual volume every 4 hours o Continue with speech therapy.

 Parenteral Nutrition  Nutrients are provided intravenously  Patients unable to digest or absorb enteral nutrition or are in highly stressed physiological states  Peripheral or central line  Initiating parenteral nutrition  Preventing complications  Restorative and Continuing Care  Medical nutrition therapy (MNT) o Specific nutritional therapy usage for treating illness, injury, or a certain condition  Necessary for o Metabolizing certain nutrients o Correcting nutritional deficiencies o Eliminating foods that worsen disease states  Most effective with collaborative health care team and dietitian  Medical Nutrition Therapy  Gastrointestinal diseases o Peptic ulcer etiology  Helicobacter pylori  Stress  Acid overproduction  Peptic ulcer treatment o Avoid caffeine o Avoid spicy foods o Avoid aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) o Consume small, frequent meals Inflammatory bowel disease o Crohn’s and idiopathic ulcerative colitis  Elemental diets  Parenteral nutrition  Vitamins and iron supplements  Fiber increase  Fat reduction  Large meal avoidance  Lactose and sorbitol avoidance  Medical Nutrition Therapy  Diabetes mellitus o Type 1: insulin and dietary restrictions o Type 2: exercise and diet therapy initially  Individualized diet  Carbohydrate consistency and monitoring  Saturated fat less than 7%  Cholesterol intake less than 200 mg/dL  Protein intake 15% to 20% of diet  Goals  Cardiovascular diseases 

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American Heart Association (AHA) dietary guidelines o Balance caloric intake and exercise. o Maintain a healthy body weight. o Eat a diet rich in fruits, vegetables, and complex carbohydrates. o Eat fish twice per week. o Limit foods and beverages high in sugar and salt.\Limit transsaturated fat to less than 1%. and cancer treatment Malignant cells compete with normal cells for nutrients. Anorexia, nausea, vomiting, and taste distortions are common. Malnutrition associated with cancer increases morbidity and mortality. Radiation causes anorexia, stomatitis, severe diarrhea, intestinal strictures, and pain. Nutrition management.

 Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)  Body wasting and severe weight loss  Severe diarrhea, GI malabsorption, altered nutrient metabolism  Hypermetabolism as a result of cytokine elevation  Maximize kilocalories and nutrients  Encourage small, frequent, nutrient-dense meals with fluid in between  Case Study (Cont.)  What nursing actions are appropriate for evaluating whether goals have been met?  Consider the patient’s perspective.  Check measurable outcomes.  Consult with interdisciplinary staff.  Evaluation  Through the patient’s eyes  Patients expect nurses to recognize when the outcomes are unsuccessful and modify the plan  Patient outcomes  Compare actual to expected  Use multidisciplinary collaboration...