Nutrition Learning Package PDF

**[Introduction to Nutrition]** **OVERVIEW** **Good nutrition is important for optimal health and wellness. Many people with chronic illnesses have special nutrition and dietary requirements. As a registered practical nurse, you play a vital role in assisting patients across the lifespan, in a var...

**[Introduction to Nutrition]** **OVERVIEW** **Good nutrition is important for optimal health and wellness. Many people with chronic illnesses have special nutrition and dietary requirements. As a registered practical nurse, you play a vital role in assisting patients across the lifespan, in a variety of health care environments and settings, to maintain optimal nutritional health.** As a nurse it is important that you have well developed knowledge and understanding of healthy nutrition because there is a direct correlation between nutrition and chronic illness. LEARNING OBJECTIVES ------------------- Throughout this learning package you will develop knowledge and understanding of: - nutrients -- classifications, functions, food sources - nutritional supplements and their use - nutrition and dietary concerns of Indigenous Peoples - various cultural nutrition and dietary concerns - nutrition across the lifespan - best practice guidelines of basic nutrition - the risks and complications of poor nutrition - various types of special diets - enteral nutrition -- types, purposes, complications including signs and symptoms, and best practice guidelines - intravenous therapy -- sites, reasons, complications including signs and symptoms, and best practice guidelines - fluid balance in the body PRE-CLASS ACTIVITIES -------------------- Complete the following in preparation for class: 1\. Describe the following terms related to nutrition: +-----------------------------------+-----------------------------------+ | Term | Description | +===================================+===================================+ | absorption | | +-----------------------------------+-----------------------------------+ | aspiration | | +-----------------------------------+-----------------------------------+ | calorie | | +-----------------------------------+-----------------------------------+ | dehydration | | +-----------------------------------+-----------------------------------+ | digestion | | +-----------------------------------+-----------------------------------+ | dysphagia | | +-----------------------------------+-----------------------------------+ | edema | | +-----------------------------------+-----------------------------------+ | enteral nutrition | | +-----------------------------------+-----------------------------------+ | feeding tube | | +-----------------------------------+-----------------------------------+ | fluid balance | | +-----------------------------------+-----------------------------------+ | fluid restrictions | | +-----------------------------------+-----------------------------------+ | food-borne illness | | +-----------------------------------+-----------------------------------+ | gastrostomy tube | | +-----------------------------------+-----------------------------------+ | gavage | | +-----------------------------------+-----------------------------------+ | ingestion | | +-----------------------------------+-----------------------------------+ | intake and output | | +-----------------------------------+-----------------------------------+ | intravenous cannula/catheter | | +-----------------------------------+-----------------------------------+ | intravenous therapy | | +-----------------------------------+-----------------------------------+ | malnutrition | | +-----------------------------------+-----------------------------------+ | nasogastric tube | | +-----------------------------------+-----------------------------------+ | nutrient | | +-----------------------------------+-----------------------------------+ | nutrition | | +-----------------------------------+-----------------------------------+ | optimal nutritional status | | +-----------------------------------+-----------------------------------+ | parenteral nutrition | | +-----------------------------------+-----------------------------------+ | percutaneous endoscopic | | | gastrostomy tube | | +-----------------------------------+-----------------------------------+ | regurgitation | | +-----------------------------------+-----------------------------------+ | total parenteral nutrition | | +-----------------------------------+-----------------------------------+ | under-nutrition | | +-----------------------------------+-----------------------------------+ 2\. Explain the best practice guidelines of basic nutrition. 3\. Complete the following chart related to specific substances in the body: Substance Description (definition, function, examples) ----------- ---------------------------------------------- enzyme hormone protein [Nutrients] The most important nutrient necessary for life is water. Water serves many purposes in the body, including: - acts as a solvent within which all the chemical reactions of metabolism occur - helps the body to regulate its temperature because it requires a great deal of energy to heat water and it releases a great deal of heat when it cools - forms part of a number of important chemical reactions i.e. digestion - acts as a cushion to absorb shocks, i.e. in the central nervous system, musculoskeletal system - acts as a lubricant so that body organs can move smoothly against each other - sustains cellular life 4\. What is the daily requirement of water for an adult? 5\. Identify the normal amount of water in the body of an: a\) infant b\) woman c\) man 6\. Understand the general functions of the following classifications of macronutrients and micronutrients as given in Appendix 1: a\) carbohydrates b\) lipids c\) proteins d\) vitamins e\) minerals (electrolytes) 7\. Complete the following chart identifying food sources of macronutrients and micronutrients: +-----------------------------------+-----------------------------------+ | Nutrients | Food Sources | +===================================+===================================+ | carbohydrates | | | | | | - starches | | | | | | - sugars | | +-----------------------------------+-----------------------------------+ | fats | | | | | | - saturated | | | | | | - unsaturated | | +-----------------------------------+-----------------------------------+ | proteins | | +-----------------------------------+-----------------------------------+ | vitamin A | | +-----------------------------------+-----------------------------------+ | vitamin D | | +-----------------------------------+-----------------------------------+ | vitamin E | | +-----------------------------------+-----------------------------------+ | vitamin K | | +-----------------------------------+-----------------------------------+ | vitamin B1 (thiamine) | | +-----------------------------------+-----------------------------------+ | vitamin B2 (riboflavin) | | +-----------------------------------+-----------------------------------+ | vitamin B3 (niacin) | | +-----------------------------------+-----------------------------------+ | vitamin B12 | | +-----------------------------------+-----------------------------------+ | vitamin C | | +-----------------------------------+-----------------------------------+ | calcium | | +-----------------------------------+-----------------------------------+ | iron | | +-----------------------------------+-----------------------------------+ | iodine | | +-----------------------------------+-----------------------------------+ | potassium | | +-----------------------------------+-----------------------------------+ | sodium | | +-----------------------------------+-----------------------------------+ 8\. Identify the normal serum values for the following nutrients: a\) sodium b\) potassium c\) calcium d\) magnesium e\) chloride f\) albumin g\) glucose 9\. What are the nutrition and dietary issues concerning Indigenous Peoples? 10\. Identify government, community, and nursing strategies and interventions to address the nutrition and dietary issues concerning Indigenous Peoples. 11\. Describe various cultural nutrition and dietary practices that you may encounter with your patients in your professional practice. [Nutrition Across the Lifespan] 12\. Describe nutrition across the lifespan as given in Appendix 2. 13\. Complete the following chart related to risks and complications of nutrition and eating: Risk/Complication Signs and symptoms Safety issues and emergency measures -------------------- -------------------- -------------------------------------- allergies choking/aspiration dysphagia food poisoning [Special Diets] Special diets for patients are ordered by a physician, registered dietician, registered nutritionist, or nurse practitioner, for a number of reasons such as: - a nutrient deficit - a specific illness, disorder, or disease - weight control - peri-operative process 14\. Describe the following special diets: a\) clear fluids b\) full fluids c\) soft, pureed d\) bland e\) fiber restricted f\) high fiber g\) high calorie h\) calorie controlled i\) low fat j\) regular diet k\) diabetic l\) sodium restricted [Enteral Nutrition and Parenteral Nutrition] 15\. Identify reasons why a patient would require: a\) enteral nutrition b\) parenteral nutrition c\) central parenteral nutrition d\) peripheral parenteral nutrition 16\. Describe the following types of tube feedings: a\) nasogastric b\) gastrostomy 17\. Describe the two types of enteral nutrition feedings: a\) scheduled b\) continuous 18\. Describe the risks and complications of enteral nutrition feedings. 19\. Describe the signs and symptoms of tube feeding complications. 20\. Describe the evidence-informed nursing interventions that you would implement for patients receiving enteral nutrition feedings. 21\. Identify the common sites for parenteral nutrition. 22\. What are the signs and symptoms of parenteral nutrition complications? Appendix 1 [Functions of Micronutrients and Macronutrients] +-----------------------------------+-----------------------------------+ | Vitamin A | -fat soluble. | | | | | | -manipulation of gene | | | transcription. | | | | | | -cellular differentiation, cell | | | specializations. | | | | | | -eye health, night vision. | | | | | | -homeostasis of epithelial cells. | | | | | | -activates t lymphocytes. | | | | | | -mobilization of iron storage | | | from liver to bone marrow. | | | | | | -fetal development. | +===================================+===================================+ | Vitamin D | -fat soluble. | | | | | | -calcium absorption from small | | | intestine. | | | | | | -regulation of serum calcium and | | | phosphorus. | | | | | | -bone growth. | | | | | | -regulates cell growth and | | | differentiation. | | | | | | -nerve impulse transmission. | | | | | | -apoptosis. | | | | | | -helps boost immune system. | +-----------------------------------+-----------------------------------+ | Vitamin E | -fat soluble. | | | | | | -powerful antioxidant. | | | | | | -inhibits platelet aggregation. | | | | | | -enhances vasodilation. | | | | | | -helps keep the immune system | | | strong and healthy. | | | | | | -formation of red blood cells. | | | | | | -helps cells use vitamin K. | +-----------------------------------+-----------------------------------+ | Vitamin K | -fat soluble. | | | | | | -blood clotting, bone health, | | | apoptosis. | | | | | | -helps prevent calcium build-up | | | in blood vessels and heart | | | valves. | | | | | | -helps form myelin sheath. | +-----------------------------------+-----------------------------------+ | Vitamin B1 | -water soluble. | | | | | | -helps break down glucose for | | | cells to use. | | | | | | -activates enzymes for cellular | | | function. | | | | | | -carbohydrate metabolism. | | | | | | -necessary component in ATP, DNA, | | | and RNA production. | | | | | | -nerve impulse conduction. | | | | | | -metabolism of acetylcholine, | | | serotonin, and adrenalin. | +-----------------------------------+-----------------------------------+ | Vitamin B2 | -water soluble. | | | | | | -cellular energy production. | | | | | | -cellular metabolism of | | | macronutrients. | | | | | | -necessary for the function of | | | other vitamins. | | | | | | -antioxidant. | | | | | | -necessary for growth of hair, | | | skin, and nails. | | | | | | -helps build tissues in the body. | | | | | | -helps stimulate red blood cell | | | production. | | | | | | -necessary for cellular | | | respiration. | +-----------------------------------+-----------------------------------+ | Vitamin B3 | -water soluble. | | | | | | -nervous system functioning. | | | | | | -causes carbohydrates to be | | | converted to glucose for cellular | | | energy. | | | | | | -genome stability, helps DNA | | | repair. | | | | | | -reduces serum cholesterol. | | | | | | -stimulates adrenal glands to | | | synthesize hormones. | +-----------------------------------+-----------------------------------+ | Vitamin B12 | -water soluble. | | | | | | -formation of nerve tissue and | | | red blood cells. | | | | | | -cellular metabolism. | | | | | | -synthesis and regulation of DNA. | | | | | | -synthesis of fatty acids and | | | energy production. | | | | | | -an essential growth factor. | +-----------------------------------+-----------------------------------+ | Vitamin C | -water soluble. | | | | | | -stimulates B lymphocytes. | | | | | | -plays a role in the chemical | | | process of synthesizing DNA & RNA | | | in phagocytes and other | | | leukocytes. | | | | | | -antioxidant | | | | | | -formation of collagen -- eyes, | | | bones, skin, blood vessels, | | | muscle tissue, tendons, | | | ligaments. | | | | | | -stimulates the adrenal glands to | | | synthesize norepinephrine. | | | | | | -inhibits histamine. | | | | | | -prevents formation of | | | carcinogenic nitrates in stomach. | | | | | | -helps heal wounds. | | | | | | -helps prevent bleeding. | | | | | | -improves absorption of iron into | | | bloodstream by small intestine. | | | | | | -bile production. | +-----------------------------------+-----------------------------------+ | Calcium | -blood clotting. | | | | | | -muscle tissue contraction. | | | | | | -promotes healthy bone and teeth | | | growth and development. | +-----------------------------------+-----------------------------------+ | Phosphorus | -part of cell membrane, RNA, and | | | DNA. | | | | | | -activates most hormones and | | | enzymes. | | | | | | -necessary for cellular energy | | | production. | | | | | | -helps maintain normal blood pH | | | homeostasis. | | | | | | -helps hemoglobin attach to red | | | blood cells. | +-----------------------------------+-----------------------------------+ | Iron | -part of hemoglobin molecule. | | | | | | -responsible for oxygen | | | transport. | | | | | | -antioxidant. | | | | | | -helps leukocytes destroy | | | bacteria. | | | | | | -some enzymes contain iron -- | | | necessary for DNA synthesis. | | | | | | -muscle tissue growth and | | | development. | +-----------------------------------+-----------------------------------+ | Iodine | -normal thyroid gland function | | | and synthesis of thyroid | | | hormones. | | | | | | -cellular metabolism. | +-----------------------------------+-----------------------------------+ | Potassium | -nerve impulse transmission and | | | electrical conduction, muscle | | | tissue contraction, and heart | | | function. | | | | | | -function of enzymes involved in | | | carbohydrate metabolism. | +-----------------------------------+-----------------------------------+ | Sodium | -regulates extracellular fluid | | | volume. | | | | | | -maintenance of concentration and | | | charge differences across cell | | | membranes. | | | | | | -absorption of amino acids, | | | glucose molecules and water | | | molecules from small intestine | | | into bloodstream. | +-----------------------------------+-----------------------------------+ | Carbohydrates | -most important fuel source for | | | all cells; provides energy for | | | cells. | | | | | | -helps regulate and maintain | | | plasma glucose homeostasis. | | | | | | -helps prevent cells from using | | | protein as a fuel source. | | | | | | -used to build some structures in | | | the body. | +-----------------------------------+-----------------------------------+ | Fats | -protection, insulation, energy | | | source. | | | | | | -helps provide structure to cell | | | membrane. [ ] | +-----------------------------------+-----------------------------------+ | Proteins | -structural framework for hair, | | | nails, skin, and other body | | | parts. | | | | | | -tissue growth and repair. | | | | | | -functions as hormones to | | | regulate various physiological | | | processes. | | | | | | -helps muscle tissues contract. | | | | | | -immune function -- antibodies | | | are proteins. | | | | | | -transportation. | | | | | | -enzymes are made of proteins | | | that function in regulating | | | biochemical | | | | | | reactions in the body. | | | | | | -regulates and maintains fluid | | | balance. | | | | | | -blood clotting. | +-----------------------------------+-----------------------------------+ Appendix 2 [Nutrition Across the Lifespan] +-----------------------------------+-----------------------------------+ | Infant | -formula or breast milk. | | | | | 1-12 months | -regular cow\'s milk should not | | | be given to infants before 9-12 | | | months - may cause GI upset, | | | bleeding, and is too concentrated | | | for infant\'s kidneys. | | | | | | -newborn infant's stomach | | | capacity is 90 ml; feedings are | | | required q2-4h. | | | | | | -fluid balance is critical | | | because of higher metabolic rate, | | | immature kidneys, and greater H20 | | | loss through skin & lungs. | | | | | | -total daily nutritional | | | requirement for newborn is 80-100 | | | ml/kg of body weight. | | | | | | -newborn usually fed on demand - | | | when baby is hungry; demonstrates | | | being full by sleeping or slowing | | | sucking. | | | | | | -after feeding, position lateral | | | or supine (to reduce risk of | | | SIDS). | | | | | | -regurgitation is common. | | | | | | -6 months old can sit up, | | | decreased sucking reflex. | | | | | | -strained or pureed foods | | | introduced at 4-6 months of age; | | | in order: cereal (rice), fruits, | | | veggies (yellow before green), | | | strained meats. | | | | | | -introduce foods 1 at a time; new | | | food every 5 days. | | | | | | -teeth come at 7-9 months -- | | | infant beginning to chew -- | | | experience different textures of | | | food, enjoys finger foods. | | | | | | -begin using a cup at 12 months; | | | milk intake is approximately 600 | | | ml/day. | +===================================+===================================+ | Toddler | -maturing GI tract, can eat most | | | foods, usually 3 meals/day plus | | 12-36 months | snacks. | | | | | | -can feed self, eats most adult | | | foods by 3 years of age. | | | | | | -developing independence -- | | | refuses certain foods. | | | | | | -mealtime should be short because | | | of decreased attention span. | | | | | | -ritualistic -- eat foods in | | | certain order, accompanying | | | certain foods with a particular | | | drink. | | | | | | -a toddler weighing 15 kg needs | | | approximately 1250 ml of fluid/24 | | | hrs. | | | | | | -caloric requirement 1200-1800 | | | kcal/day because of increased | | | growth rate. | | | | | | -may be eating combination of | | | prepared toddler foods & adult | | | foods. | | | | | | -deficiencies of Fe, Ca, vitamins | | | C & A are common. | | | | | | -do not use food as reward or | | | punishment. | | | | | | -have scheduled meals, sleep and | | | snack times to promote optimum | | | appetite and nutritional | | | behaviors/habits. | +-----------------------------------+-----------------------------------+ | Preschooler | -eats adult foods; 1600 kcal/day | | | requirement. | | 3-5 years | | | | -needs help cutting meat, may | | | still spill milk when pouring | | | from a large container. | | | | | | -learning how to use utensils, | | | learning table manners, may enjoy | | | helping in the kitchen. | | | | | | -requires snacks between meals -- | | | very active, busy. | +-----------------------------------+-----------------------------------+ | School age | -requires 2400 kcal/day; must eat | | | breakfast; requires protein rich | | 6-12 years | diet to sustain prolonged | | | physical and mental effort of | | | school. | | | | | | -requires 1700 ml of fluid/day. | | | | | | -learn most of their eating | | | habits/patterns from parents. | | | | | | -generally eats lunch at school. | | | | | | -many dietary problems stem from | | | children making food choices, not | | | parents. | | | | | | -obesity is a serious problem. | +-----------------------------------+-----------------------------------+ | Adolescent | -need for nutrients and calories | | | increases - another growth spurt. | | 13-19 years | | | | -eat frequently and large | | | amounts. | | | | | | -snack frequently, eat high | | | calorie foods, fast foods. | | | | | | -food choices related to | | | physical, social, and emotional | | | factors, and impulses. | | | | | | -common problems related to | | | nutrition and self esteem include | | | obesity, anorexia, bulimia. | | | | | | -calcium necessary for growth | | | spurt; 1300 mg/day. | +-----------------------------------+-----------------------------------+ | Adult | -nutritional habits established | | | during young adulthood often lay | | 20-65 years | the foundation for patterns | | | maintained throughout life. | | | | | | -generally aware of Canada's Food | | | Guide (CFG) but may not know | | | details. | | | | | | -females at risk for iron | | | deficiency anemia and require | | | iron-rich diet. | | | | | | -obesity and HTN begin. | | | | | | -middle-aged adults should follow | | | a meal plan congruent with | | | activity level and health state. | | | | | | -may need to reduce caloric | | | intake, be aware of cholesterol | | | levels. | | | | | | -decreased metabolism in middle | | | adulthood, and weight gain is | | | common at this time of life. | +-----------------------------------+-----------------------------------+ | Elderly adult | -should follow CFG and a meal | | | plan congruent with activity | | \>65 years | level and health state. | | | | | | -health state may be | | | deteriorating due to chronic | | | disease. | | | | | | -may need to reduce portion size, | | | increase protein, fiber intake. | | | | | | -tooth loss, impaired senses may | | | alter eating habits. | | | | | | -some older people who live alone | | | may not cook for themselves or | | | may eat alone -- may adopt poor | | | dietary habits. | | | | | | -problems associated with | | | nutrition in elderly: | | | | | | - difficulty chewing | | | | | | - lowered glucose tolerance, | | | lowered lactase tolerance | | | | | | - decreased social interaction, | | | increased loneliness | | | | | | - loss of appetite | | | | | | - diminished senses | | | | | | - limited income | | | | | | - difficulty sleeping at night | +-----------------------------------+-----------------------------------+