Notes - Nutrition.pdf

Sri Rahaya Nafitri Abdul Razak (U6240037) NUTRITION LEARNING OUTCOME i. Identify essential nutrients and their dietary sources. ii. Identify factors influencing nutrition. iii. Identify patients who are candidates for modified diets. iv. List foods that are restricted or supplemented for patie...

Sri Rahaya Nafitri Abdul Razak (U6240037) NUTRITION LEARNING OUTCOME i. Identify essential nutrients and their dietary sources. ii. Identify factors influencing nutrition. iii. Identify patients who are candidates for modified diets. iv. List foods that are restricted or supplemented for patients who are receiving modified diets INTRODUCTION Nutrition (is what a person eats & how the body uses it) is the sum of all interactions between on organism and food it consumes. Nutrients are organic and inorganic substances found in the foods that are required for body functioning. Adequate food intake consists of a balance of nutrients: water, carbohydrates, proteins, fats, vitamins, and minerals. Major functions of nutrients: o Providing energy for body process and movement o Providing structural material for body tissues. o Regulating body processes. Carbohydrates, fats, protein, minerals, vitamins, and water are referred to as macronutrients, needed in large amounts to provide energy. Micronutrients are those vitamins and minerals that are required in small amounts to metabolize the energy-providing nutrients. ESSENTIAL BODY NUTRIENTS I) Carbohydrates (potatoes, bread, corn, rice, oats): provide energy Monosaccharides: Glucose, fructose, galactose Disaccharides: Sucrose, lactose, maltose Polysaccharides: starch, dextrin, glycogen, cellulose, hemicellulose II) Fats (cheese, butter, avocado, egg yolk): provides long term energy, insulation and protection. Linoleic acid, linolenic acid, arachidonic acid III) Proteins (egg, fish, meat): builds new tissues, antibodies, enzymes, hormones, and other compound. Amino acids Phenylalanine, lysine, isoleucine, leucine, methionine, valine, tryptophan, threonine, and (required only by infants) histidine IV) Vitamins (vegetables and fruits): facilitate use of other nutrients, involved regulating growth and manufacturing hormones Fat soluble: Vitamins A, D, E, and K Water soluble: Vitamins B and C V) Minerals (cereals, bread, meat, milk, nuts): helps build bones and teeth, aid in muscle function and nervous system activity Calcium, chloride, iron, magnesium, phosphorus, potassium, sodium, sulphur VI) Water (plain water, milk): dissolves and carriers nutrients, removes waste and regulates body temperature Trace elements FACTORS AFFECTING NUTRITION Habits about eating are influenced by: i. Development - Adolescence rapid period of growth with increased needs for nutrients - Older adults need fewer calories and need some dietary changes with their increased risk for CHD, Osteoporosis & Hypertension ii. Sex - Nutrient requirements differ between males & females (body composition and reproductive functions) - Larger muscle mass in men greater needs for calories and proteins - Females need more iron than men prior to menopause/menstrual - Pregnant and lactating women have increase fluid & calorie needs iii. Ethnicity and Culture - Universal accepted guidelines; eat a wide variety of foods to supply adequate nutrients and eat moderately to maintain body weight iv. Beliefs about Food - Beliefs about effects of foods on health can affect food choice; people acquire their beliefs from television, magazines, and other media v. Personal Preferences - People develop likes and dislikes based on associations with foods (foods prepared by mother or grandmother) and are sometimes carried through adulthood; likes and dislikes can also be related to familiarity - Preferences in tastes, smells, flavors, temperatures, colors, shapes, and sizes of food influence person’s food choices; textures also play great role vi. Religious Practices - Muslims are prohibited from eating pork - Hindus do no eat beef vii. Lifestyle - People who stay at home prepare foods from scratch - People in hurry might eat more ready made meals viii. Economics - What, how much, and how often a person eats is affected by socioeconomics status; also affected: food preparation and food storage facilities ix. Medications and Therapy - Some medications may change appetite, disturb taste perception or interfere with nutrient absorption or excretion - Some nutrients can decrease drug absorption; others enhance absorption - Older adults are at increased risk for drug food interactions due to number of medications they take, decrease in renal or hepatic functions and age-related changes - Chemotherapy may adversely affect eating patterns and nutrition x. Health - Client’s health status: missing teeth, ill-fitting dentures & dysphagia can prevent person from getting adequate nourishment - Disease processes & surgery of GI tract can affect digestion, absorption, metabolism and excretion; create nausea, vomiting, diarrhea - Gallstones (affecting floe of bile) will affect lipid digestion xi. Alcohol Consumption  - Alcohol has large number of calories, can lead to weight gain; excessive alcohol use contributes to nutritional deficiencies, can depress appetite, toxic effect on intestinal mucosa leading to decrease in absorption of nutrients xii. Advertising - Influences people’s food choices and eating patterns to some extent; advertisment xiii. Psychological Factors - Anorexia and weight loss can indicate severe stress or depression - In female adolescents: bulimia (binge eating and purging); anorexia nervosa (distorted body self-perception, food restriction, inappropriate eating habits or rituals, obsession with having thin figure, irrational fear of weight gain). NORMAL AND THERAPEUTIC NUTRITION Normal nutrition is based on recommended daily dietary allowances designed for the maintenance of health. Therapeutic modification of nutritional needs may be based on a pt.’s disease condition associated with an excess or deficiency of a particular nutrient. Therapeutic diets may include alterations of minerals, vitamins, proteins, carbohydrates, fats, and fluids, as well as alterations of their consistency to facilitate the pt.’s intake. Commented [JAS1]: Explain factors affecting nutrition Route of Feeding Oral Enteral (nasogastric tube, gastrostomy tube, jejunostomy tube, nasojejunal tube, nasoduodenal tube) Parenteral (IV, PPN, TPN) Enteral Feeding for Nutritional Support Enteral nutrition may be prescribed for pts who are unable or unwilling to eat or those who need a supplement to ingested food, as well as for pts in catabolic states with intensive caloric requirement (burn, trauma). Alternative feeding methods that ensure adequate nutrition include enteral (through the GI system) methods. Enteral nutrition (EN), also referred to as total enteral nutrition (TEN), is provided when the pt. cannot ingest foods or the upper GI tract is impaired and the transport of food to the small intestine is interrupted. Enteral feedings are administered through nasogastric and small-bore feeding tubes, or through gastrostomy or jejunostomy tubes. Enteral feeding is preferred over parenteral (intravenous) nutrition because it is safer, less expensive, and associated with fewer complications It helps to maintain GI function and speeds regeneration of the small intestine, which receives its nutrition from food directly rather than from the bloodstream. Enteral nutrition preserves production of humoral antibodies, reduces gut bacterial over- growth, and, by helping to maintain the gut’s protective mucosal barrier, promotes gut motility & reduces risk of sepsis. Since the small intestine, postoperative feeding into the small intestine is feasible even through the pt. is NPO/NBM. Enteral formulas come in powder form to reconstitute or as ready-to-use liquids. They contain all or just one of the following: protein, carbohydrates, fat, electrolytes, and vitamins and minerals, depending on the pt.’s needs. Isotonic formulas provide 1 cal/mL and are most commonly used. Modified formulas are available for pt.s with specific nutritional requirements: Lactose- free, or lactose-containing, fiber-containing, elemental (pre-digested), or modular formulations that provide additional macronutrient components (lipid, carbohydrate, or protein). Specialized formulas are also available for trauma pt. Parenteral Nutrition Parenteral nutrition (PN) is intravenous administration of nutrition, which may include protein, carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements for patients who cannot eat or absorb enough food through tube feeding formula or by mouth to maintain good nutrition status. Achieving the right nutritional intake in a timely manner can help combat complications and be an important part of a patient’s recovery. Parenteral nutrition is sometimes called Total Parenteral Nutrition (TPN). is a modality that provides nutrients, multivitamin supplementation, and calories intravenously to pt.s who cannot be fed orally or who are unable to meet their caloric requirements via the enteral route. PN is invasive and costly, and it can contribute to infectious complications (line sepsis), volume overload, and hyperglycemia but shown to decrease morbidity & mortalaity in critically ill & severely malnourished pt.s Who Receives Parenteral Nutrition? People of all ages receive parenteral nutrition. It may be given to infants and children, as well as to adults. People can live well on parenteral nutrition for as long as it is needed. Many times, parenteral nutrition is used for a short time; then it is lessened or discontinued when the person begins to switch to tube feeding or eat enough by mouth. Parenteral nutrition bypasses the normal digestion in the gastrointestinal (GI) tract. It is a sterile liquid chemical formula given directly into the bloodstream through an intravenous (IV) catheter (needle in the vein). For What Diseases or Conditions Would Patients Need PN? Patients may need PN for any variety of diseases or conditions that impair food intake, nutrient digestion or absorption. Some diseases and conditions where PN is indicated include but are not limited to short bowel syndrome, GI fistulas, bowel obstruction, critically ill patients, and severe acute pancreatitis. Some patients may require this therapy for a short time and there are other patients who have received PN at home for a lifetime. Modified Therapeutic Diets (Assisting with special diets) Alterations in the pt.’s diet – needed to treat a disease process, eg; diabetes mellitus, to prepare for a special examination or surgery, to increase or decrease weight, to restore nutritional deficits, or to allow an organ to rest and promote healing. Diets are modified in one or more of the following aspects: texture, kilocalories, specific nutrients, seasonings, or consistency. Modified therapeutic diets include: i) Bland Diet is used to promote the healing of the gastric mucosa by eliminating food sources that are chemically and mechanically irritating. Used to manage duodenal ulcers, gastric ulcers, and postoperative gastric surgery. a) Instruct pt. that bland diets are presented in stages with the gradual addition of certain foods. b) Provide frequent, small feedings during active stress periods. Establish regular meals and food patterns when condition permits. Foods allowed include: a) Milk, butter, eggs (not fried), custard, vanilla ice cream b) Cooked refined or strained cereal, enriched white bread. c) Gelatin: pureed soups d) Baked or broiled potatoes Examples of foods that are eliminated include: a) Spicy & highly seasoned foods b) Raw foods c) Very hot & cold foods d) Gas-forming foods e) Coffee, alcoholic beverages, carbonated drinks f) High-fat-content foods (some butter and margarine allowed) ii) Soft Diet Any food that can be easily chewed and digested can be included in the diet. Low-residue (low-fiber). Soft diet is ordered for: are edentulous have poorly fitted dentures have difficulty chewing / swallowing post-operative pt. iii) Pureed Diet A pureed diet provides food that has been mashed, minced, or ground. is modification of the soft diet. Liquid may be added to the food, which is then blended to a semisolid consistency. iv) Blenderized Liquid Diet Contains food and liquid that are blenderized to liquid form. Used for individuals who cannot chew, swallow, or tolerate solid food; or may be used for gastrostomy feeding. v) Clear Liquid Diet Limited to water, tea, coffee, clear broths, carbonated beverages, strained and clear juices, Note that “clear” does not mean “colorless” provides the pt. with fluid and carbohydrate ( in the form of sugar), does not supply adequate protein, fat, vitamins, minerals, or calories. it’s a short-term diet (24 – 36 hours) provided after certain surgeries or in the acute stages of infection, particularly of the GI tract. The major objectives of this diet are to relieve thirst, prevent dehydration, and minimize stimulation of the GI tract. vi) Full Liquid Diet Contains only liquids or foods that turn to liquid at body temperature, such as ice cream. Indication for pt. who have; GI disturbances Cannot tolerate solid / semisolid foods Not recommended for long-term use because it is low in iron, protein, and calories. It’s cholesterol content may be high because of the amount of cow’s milk offered. Pt.s who must receive only liquids for long periods are given nutritional supplement; eg; Ensure / Sustacal. Plan six / more feedings per day may encourage a more adequate intake. vii) Modification for Disease Special diets may be prescribed to meet requirements for disease processes or altered metabolism. Eg; a) Diabetes Mellitus pt. must follow diabetic diet b) Cardiac pt. may need sodium & cholesterol restrictions c) Restricting Dietary Protein For pt. with renal insufficiency, hepatic coma, phenylketonuria limit high-protein foods d) Restricting Dietary Fat To reduce risk for and to manage cardiovascular diseases, diabetes mellitus & high serum cholesterol levels.  A modified-fat diet : cystic fibrosis, gallbladder disease, obstructive jaundice, pancreatitis , & liver disease. e) Restricting mineral nutrients (Sodium, Potassium) A restricted sodium diet – used to manage hypertension, liver disease, heart failure (edema) , renal insufficiency. Correct or control the retention of sodium and water in the body by limiting sodium intake : in the diet / medications. f) Providing consistent carbohydrate Diets Foods included on the diet are balanced Treatment for diabetes g) Providing Nutrient-Enhanced Diets i) An increased potassium diet ii) A high-iron diet iii) A high-calcium diet h) Providing Progressive Diets i) Dietary Fiber: Insoluble fiber & Soluble fiber ii) A low-fiber diet for intestinal diseases iii) A high-fiber diet to treat constipation & diverticulosis i) Postoperative Diet Progression Nil by Mouth (NBM) / Nothing by mouth (NPO) Clear liquid diet : 1,000 – 1,500 mL/day of liquid foods : water, tea, clear juices Full liquid diet : milk products, creamed soups... NURSING INTERVENTION TO IMPROVE APPETITE i) Assessment - get medical history, current medications, nutritional status ii) Provide information on nutrient - Assist/educate patient/family members about healthy food choice and good nutritions iii) Reduce psychological stress - Eating with accompany/talk about something that can enhance your mood or enhance your appetite iv) Hygiene - take a bath, wash hands, brush teeth to removes unpleasant odors/taste v) Environment - comfortable environment, should be clean, eating at appropriate space/place, free odors and noise vi) Food - Should be warm/cold, good aroma, looks delicious/variety of foods, looks presentable vii) Physical comfort of pt. - Assist with feeding as needed SERVING A FOOD TRAY Preparation 1. Check pt.’s record for healthcare provider’s diet order. 2. Obtain dietary consult from dietician, if necessary. 3. Elicit food preferences of the pt. 4. Check all diet trays before serving to ensure the diet provided in the one ordered 5. Ensure that hot food is hot and cold food is cold. 6. Keep food trays attractive. 7. Assist pt. to empty bladder and perform hand hygiene. 8. Remove unpleasant objects. 9. Ensure pt. is allowed to eat / not (Nil By Mouth: NBM) Documentation After the pt. has completed the meal, Observe how much and what the pt. has eaten and the amount of fluid taken. Document percentage and type of food, amount of fluid intake on intake output record (I & O record).