NURS 1013 Water and Energy.pdf

NURS1013: NUTRITION Water & Energy Objectives    Explain the role of water in biological function Relate the needs for water to basic human functions Discuss the concepts of energy metabolism Water   Largest constituent of the human body (adult ≈60% of body) children and people with higher musc...

NURS1013: NUTRITION Water & Energy Objectives    Explain the role of water in biological function Relate the needs for water to basic human functions Discuss the concepts of energy metabolism Water   Largest constituent of the human body (adult ≈60% of body) children and people with higher muscle mass have higher water content Functions  Solvent- medium in which biochemical reactions take place  Regulates body temperature- absorb heat and dissipate it to maintain core temperature  Provides structure to cells, skin integrity (Jyoti, Kumar, & Sharma, 2018) Water  Functions  Lubricant of joints, eyes, MM  Maintenance of vascular volume  Shock Absorbent protection of eyes, spinal cord, fetus  Part of GI secretions for digestion, absorption & excretion  Facilitates transportation and elimination ◼ Nutrients are transported ◼ Byproducts of metabolism are excreted in water in urine and faeces. (Ben-Nun, 2011) Terms related to water         Insensible water loss:- water loss that is difficult to measure- respiratory and fecal water losses Sensible water loss :- measurable water loss- include water lost in urine Water balance:- difference in total water gain and losses in the body Euhydration:- state of water balance Hypohydrtaion:- water deficit Hyperhydration:- excess water Dehydration:- deficient water and solutes such as electrolytes Water requirements.pdf Factors affecting Fluid Balance  Physiological      Loss of muscle mass= water loss Sensitivity to vasopressin- impairs the renal tubules ability to reabsorb water Inability to concentrate urine (higher volume to excrete solutes Decrease thirst sensitivity Medical        Poor cognition 2o meds/Dx- low intake Impaired swallowing- poor intake Medications; diuretics increase loss or those that impair thirst GI losses- vomiting, GI suction, diarrhea Urinary losses- polydipisia with DM and diuretics Exudative wounds or decubiti Insensible losses- humidity, sweating, fever, increased respiratory rate Assessing Hydration 7   The elderly person is at risk of dehydration because of physiological changes in the elderly including dysphagia, dependency and skin changes. The nurse should be keen to assess the following ◼ The greater the body water loss the more severe the symptoms ▪Urine output ▪Tenting of skin over sternum ▪Postural changes in blood pressure ▪Dry mucous membrane ▪Lethargy and headache ▪Swollen tongue ▪Colour of the urine ▪Weight loss ▪Sunken eyes ▪Confusion ▪Constipation ▪hallucinations (Robinson, 2007; Tucker & Dauffenbach, 2011) Recommended Intake      Uses AI and includes water from beverages and water contained in foods 3.7L/d males 19 years and older 2.7L/d females 19 years and older Recommendation is the same for older adults to ensure intake is not limited Sources:- liquids, fruits, vegetables References    Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson. Robinson, J. (2007). Water, electrolytes and acidbase balance. In J. Mann & A. S. Truswell (Eds.), Essentials of human nutrition (pp 100-111). New York, USA: Oxford University Press Water requirements.pdf Energy  Energy: term used to describe available usable power, whether it is chemical, mechanical, electrical or other forms.  It is the primary currency of nutrition. It is a human requirement to maintain warmth and drive all the processes of life.  It is created from a chemical combustion of food which requires oxygen and releases carbon dioxide.   Energy balance:- The relationship between energy intake and energy used body to perform physical functions Energy expenditure: all the energy used by the body. (Prentice, 2007; Tucker & Dauffenbach, 2011) Energy  A calorie is a unit of energy used to express the energy yield of foods and energy expenditure by the body ▪   (Dulloo & Schutz, 2005) The amount of heat needed to raise the temperature of 1g of water through 1⁰C Kilocalories is the measurement for the chemical form of energy in foods ◼  (Tucker & Dauffenbach, 2011) Nutritionally kilocalorie is used (1000 calories) heat required to raised 1kg of water through 1⁰C ◼ (Dulloo & Schutz, 2005) Energy      Bomb calorimetry is the heat change associated with the combustion of food compound; method used to determine the energy contained in a food. Kilojoule: the amount of energy needed to move 1kg with an acceleration of 1 metre per second (1kJ= 0.239 kCal) Energy is provided by the metabolism of fats, alcohol, carbs, & protein. Chemical energy is the total energy that would be liberated from food if it was combusted in oxygen. Gross energy (GE) is the total chemical energy of food (Prentice, 2007; Tucker & Dauffenbach, 2011) Energy  Portion of GE is unavailable for metabolism Not all can be absorbed or digested e.g. dietary fibre  Some energy is lost in faeces   Portion of energy (GE) absorbed from the digestive tract is called Digestible Energy (DE) Human oxidative pathways do not totally liberate all the energy from the digestible form  Some energy lost in urine and trapped in ammonia; last stage of protein metabolism   Metabolizable energy is the actual energy available for metabolism (Prentice, 2007) Energy      Energy expenditure is the energy used by the body in a day and is affected by several components which help to determine the unique needs of an individual Total Energy Expenditure(TEE) :- sum of all energy requiring processes in the body as well as energy needed for physical activity (PA) Basal Metabolism (BMR- Basal Metabolic Rate):- energy required by the body to meet vital functions; when the body is at complete rest Unit of BMR is kcal/d- when it is expressed as this it is referred to as Basal energy expenditure (BEE) REE- energy needed to rest quietly and awake after a meal (Prentice, 2007; Tucker & Dauffenbach, 2011) Energy  Factors impacting BMR  Body habitus- fat free mass (muscles)  Gender difference:- which may be due to skeletal muscle mass differences  Age:- being debated regarding the decline of fat free mass  Thermoregaulation challenges:- higher BMR in infants and hyperthermia  Ambient temperature:- low causing shivering increases BMR  Growth and development:- infancy, childhood, adolescence, pregnancy and lactation- increases BMR (Prentice, 2007; Tucker & Dauffenbach, 2011) Energy    Thermic effect of food:- digestion, metabolism and storage of nutrients requires nutrients. This metabolic cost is 10% of the energy value of the food itself Physical activity has an energy cost Subdivided into actual exercise and nonexercise activity thermogenesis – activities requiring muscle contraction- doing, ADLs, talking, fidgeting  Energy cost depends on intensity and duration  Energy used in physical activity is a ratio/% of BEE and is called physical activity level (PAL).  PAL described as sedentary, moderate and vigorous (Prentice, 2007; Tucker & Dauffenbach, 2011) Energy measurement methods     Indirect Calorimetry:- measures the byproducts of energy expenditure- CO2, H2O & heat- in proportion to the amount of O2 used. Direct Calorimetry :- process used to measure the direct energy expenditure of human by the amount the of heat generated by the body Stable isotope methods:- assess CO2 turnover from the differential disappearance from urine Energy balance if the difference between intake and expenditure. Energy http://www.google.com.jm/imgres?q=energy+balance Energy  Balance exists if intake approximates expenditure. Macronutrient- fat, carbs, protein and alcohol- Atwater 7kcal/g- intake  Expenditure- basal metabolism, physical activity, thermic effect of food  Adults balance- weight maintenance; children- foster normal growth and development  Negative balance- insufficient to support needs; weight loss  ◼  Occurs when- insufficient intake, increased expenditure, both Positive balance- intake exceed expenditure ◼ Occurs due- increased intake over expenditure, decreased expenditure, or both Energy  Biology- genetics, & hormones may impact satiety, appetite, and metabolism that complicates energy balance Energy Requirements     Large percentage of the population is overweight, (2/3rds Americans- overweight/obese); ½ waking hours doing sedentary activities Energy consumption- larger portions being served, increased intake. Goal- prevent obesity while providing adequate energy for nutritional needs AdultsFemales- 354- (6.91 *age) + PA * (9.36* wt + 726*ht)  Males- 662- (9.53 *age) + PA * (15.91* wt + 539*ht)  Wt- kg, ht- m; PA= 1, 1.16, 1.31, 1.56- sedentary, lightly active, active, very active  References      Ben-Nun, L. (2011).Water and its Role for Human Health. B.N. Publications House, Israel Prentice, A. M. (2007). Energy. In J. Mann & A. S. Truswell (Eds.), Essentials of human nutrition (pp 73-99). New York, USA: Oxford University Press. Jyoti, R., Kumar, S. U., & Sharma, D. N. (2018). Role of adequate water intake in purification of body. Environment Conservation Journal, 19(1&2), 183186. Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson. Energy requirements energy requirements.pdf Assignment     Describe the relationship between protein metabolism and the metabolizable energy content of beef List some of the medical consequences of positive energy balance Outline the process of determining the energy requirements for an adult male who is active and weighs, 78kg and is 1.8 m tall Differentiate among the WHO classifications of underweight, normal weight, overweight and obese