Nutrition Slideshow PDF

Chapter 45 Nutrition NURS 300  Objectives 1. Explain the effects of a well-balanced diet on the body throughout the life span. 2. Summarize the process of digestion and absorption. 3. Explain the MyPlate program and its value in planning meals for hea...

Chapter 45 Nutrition NURS 300  Objectives 1. Explain the effects of a well-balanced diet on the body throughout the life span. 2. Summarize the process of digestion and absorption. 3. Explain the MyPlate program and its value in planning meals for healthy nutrition. 4. List the current dietary guidelines for the general population 5. Explain the variance in nutritional requirements throughout the life span. 6. Identify risk factors that put patients at high risk for aspiration. 7. Categorize the major methods of nutritional assessment. 8. Explain the nursing management of enteral feedings. 9. Explain the approaches for preventing complications of parenteral nutrition ( PN). 10. Identify medical nutritional therapy(MNT) in relation to the medical condition of cardiovascular disease. 11. Propose how to implement diet counseling and patient teaching in relation to patient expctations. 2  Background Food security is critical for all members of a household. Food holds symbolic meaning. Medical nutrition therapy uses nutrition therapy and counseling to manage disease.  Energy Requirements breathing heartpumping Basal metabolic rate (BMR)—Energy needed at rest to maintain life-sustaining activities (Breathing, circulation, heart rate…) for a specific period of time Resting energy expenditure (REE) —Energy individual needs to consume over a 24-hour period for body to maintain all of its internal working activities while at rest Nutrients Energy necessary for the normal function of numerous body processes  Scientific Knowledge Base: Nutrients Carbohydrates Complex & simple saccharides Main source of energy Each gram of carbohydrate produces 4 kcal/g and serves as the main source of fuel (glucose) Proteins bum patients need provide a source of energyhigh protein diets (4 kcal/g) Amino acids Necessary for nitrogen balance tissue growth, maintenance & repair Fats Most calorie-dense nutrients, providing 9 kcal/g. Composed of triglycerides and fatty acids. Scientific Knowledge Base: Nutrients Water All cell function depends on a fluid environment. 60% to 70% of total body weight is water Vitamins in biochemical Eddy Essential to normal metabolism Water-soluble – B, C ii fat-soluble - A, D, E, K taken with food Minerals Essential to body as catalysts in biochemical reactions  Dietary Guidelines Dietary Guidelines Provide average daily consumption guidelines for five food groups: grains, vegetables, fruits, dairy products, & meats Dietary reference intakes (DRIs) Acceptable range of quantities of vitamins & minerals for each gender & age group Daily values Needed protein, vitamins, fats, cholesterol, carbohydrates, fiber, sodium, and potassium Daily values based on percentages of a diet consisting of 2000 kcal/day for adults and children 4 years or older Included on food labels  ChooseMyPlate ChooseMyPlate program was developed by the U.S. Department of Agriculture to replace the My Food Pyramid program. Provides basic guide for making food choices for a healthy lifestyle. Guidelines for balancing E calories; decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars.  Digestion Mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical É reactions in which food reduces to its simplest form  Metabolism & Storage of Nutrients Metabolism Biochemical reactions within the cells of the body Carbohydrates, protein, & fat metabolism produce chemical energy & maintain a balance between anabolism & catabolism Anabolism Building of more complex biochemical substances by synthesis of nutrients Catabolism an f En tinstawaI Breakdown of biochemical substances into simpler substances; occurs during physiological states of negative nitrogen balance  Absorption Small intestine, lined with fingerlike projections called villi, the primary absorption site for nutrients. 85% to 90% of water is absorbed in the small intestine __sareenguifedand Body absorbs nutrients by passive diffusion, osmosis, active transport, & pinocytosis. Absorption of carbohydrates, protein, minerals, & water-soluble vitamins occurs in the small intestine. fe Electrolytes & minerals are absorbed in colon, & bacteria synthesize vitamin K & B-complex vitamins  Elimination Chyme moves by peristaltic action through theenzymes Ifnottotalydiastedndsfh.am ileocecal valve into large intestine, where it becomes feces. entering Water absorbs in mucosa as feces move toward rectum. The longer material stays in large intestine, the more water absorbed, causing feces to become firmer.it Exercise & fiber stimulate peristalsis, & water maintains consistency. move all substances through the body  Environmental Factors Influencing Nutrition Environmental factors Lack of access to full-service grocery Food stores desert High costs of healthy food Widespread availability of less healthy foods in fast food restaurants Widespread advertising of less healthy food Lack of access to safe places to play and exercise  Developmental Considerations for Children Newborn and Infants: Rapid growth- need high protein Breastfeeding vs. formula, introduction of solid foods School Age (6-12 years): Monitor food intake Grow at slower/steadier rate, gradual decline in energy needs Adolescents: pidy Physiological age is better than chronological age for estimating nutritional needs Increase protein due to higher metabolic growth demands Females need calcium and iron Monitor for onset of eating disorders  Developmental Considerations for Adults Young and middle adults: Growth slows- Energy requirements for maintenance & repair only Pregnancy and lactation energy needs related to mother’s body weight and activity level Pregnancy requires an extra 300 calories Lactation requires an extra 500 calories E Older adults (65 years and older): Slower metabolic rate, decreased energy needs Age-related changes in appetite, taste, smell, digestive function Often require supplementation Benefit from nutritional screening Meal delivery or preparation services available  Alternative Food Patterns Vegetarian - Predominantly plant foods Ovolactovegetarian - No meat, fish, & poultry - eats eggs & milk Children at risk for protein B12 deficiencies Lactovegetarian - drinks milk but avoids eggs Vegan - consumes only plant food Lack complete proteins in single foods, use complementary proteins from two or more foods to get required amino acids. Knowledge of complementary proteins is necessary At risk for B12 deficiency, it is available only from animal sources. Fruitarian -consumes fruit, nuts, honey, and olive oil Zen macrobiotic -primarily brown rice, other grains, & herb teas Diets are nutrient poor and frequently result in malnutrition.  Assessment Anthropometry is a measurement system of size and makeup of the body Ideal body weight (IBW) - Estimate of what a person should weigh. Body mass index (BMI) É- measures weight corrected for height, serves as alternative to traditional height-weight relationships. Laboratory and biochemical tests prning w Plasma proteins such as albumin, transferrin, prealbumin, retinol binding protein, total iron-binding capacity, and hemoglobin  Assessment Dietary and health history Intake of foods & liquids - includes preferences, allergies, & the pt’s ability to obtain food. Illness/activity level to determine energy needs & compare food intake. 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; & Pt’s general nutrition knowledge Physical examination - improper nutrition affects all body systems Infoodbetakeholaly Dysphagia (difficulty swallowing) Leads to disability or decreased functional status, increased length of stay & cost of care, increased likelihood of discharge to institutionalized care, & increased mortality.  Enteral Tube Feeding Enteral feedings - administered via a feeding tube, when patient cannot meet nutritional needs by mouth. Inserted through nose into stomach or intestines, or TIYensu surgically placed through abdominal wall Nursing role: dingbisinn.gl place Insert feeding tube as ordered. Initiate enteral feeding as prescribed. all feedings liquid Advance tube feeding as tolerated; monitor for tolerance. Aspiration Precautions ftp.dniked Position with head of bed elevated a minimum of 30 degrees. Check tube placement every 4 to 6 hours. Check gastric residual volume every 4 hours.  Parenteral Nutrition liquid into stomach Parenteral nutrition (PN) is a form of specialized nutrition support provided intravenously. Patients whose GI tracts are not functioning properly and are unable to digest or absorb food benefit from PN Administered through peripheral IV (PPN) or central line (TPN) PN is a combination of amino acids, dextrose, electrolytes, vitamins, and trace elements. Adding fat emulsions (lipids) to PN supports need for supplemental kilocalories, prevents essential fatty acid deficiencies, and help control hyperglycemia Safe administration depends on meticulous management of the IV or central venous catheter (CVC), and careful monitoring to prevent or treat metabolic complications peripheral Yes nose stomach iv placedoutside of stomachto stomach placedoutside of small Heffentestines stomach small duodenum small intestines intestines  Implementation 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 When a pt needs help with eating, protect his or her safety, independence, & dignity. Restorative and Continuing Care Medical nutrition therapy (MNT) Specific nutritional therapy usage for treating illness, injury, or a certain condition Examples: Peptic ulcer disease, Crohn’s, ulcerative colitis, celiac disease, short bowel syndrome, diverticulitis, diabetes, hypertension, hypercholesterolemia, cancer, HIV/AIDS Necessary for Metabolizing certain nutrients Correcting nutritional deficiencies Eliminating foods E that worsen disease states Most effective with collaborative health care team & dietitian  Nutrition and People with IDD Healthy diets are associated with improving quality of live in individuals with IDD Medically indicated diets not always easy Does a person have a medical condition that should be considered Make sure the diet does not make the medical condition worse Weight Monitoring a person’s weight can help catch conditions early Weight loss can be an early sign of multiple issues including constipation, GERD, swallowing difficulties, cancer and neglect Escude, 2019 24  Nutrition and People with IDD Swallowing consideration Some people with IDD have swallowing difficulties- need a safe diet Change in texture of solid foods or thickness of liquids may be needed to reduce risk of choking Some individuals may require a feed tube when aspiration continues to occur Sensory and tactile considerations May only eat certain textures of foods, dislike getting their hands messy, overstuff or pocket foods frequently, or gag at the sight, smell, touch, or taste of foods Communication considerations Difficulty communicating food likes and dislikes could cause an issue with eating Exploring different ways to help the person express their preferences could help to improve oral intake Environmental considerations Behavioral and environmental circumstances can contribute to eating issues Person may not be eating because they are not allowed enough time Person may require assistance that they are not getting They may have a favorite support person that got transferred to a different job Sometimes a simple change in a person’s environment can improve their intake Medication considerations Medications have many side effects, some which can affect eating If someone is experiencing a side effect of nausea, they may not be able to express this verbally, so they may just stop eating Some sedating medications may make swallowing more dangerous 25 Constipating medications may interfere with someone’s appetite Escude, 2019