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Nutrition: Principles and Assessment, Lecture notes of Nutrition

Nashville State Community CollegeNutrition

An overview of the principles of nutrition, including macronutrients and micronutrients, and their role in the body. It also covers the assessment of nutritional status, including physical examination, laboratory values, and patient history. information on interventions for patients who are unable to meet their nutritional needs orally, such as enteral and parenteral nutrition. Safety guidelines for providing enteral nutrition are also discussed.

Typology: Lecture notes

2022/2023

Available from 03/04/2023

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Chapter 35 Nutrition
-
- Scientific Knowledge Base: Principles of Nutrition
Carbohydrates
oStarches and sugars
oFiber (soluble or insoluble)
Proteins
oAmino acids
oNitrogen balance (positive or negative)
- Anatomy and Physiology: Macronutrients – Carbohydrates
Carbohydrates = Main source of energy and fiber:
oOne gram of carbohydrate produces 4 kilocalories (kcal) of energy.
oFiber provides bulk that stimulates peristalsis.
oMain sources are plant foods and lactose.
oSome stored in liver and muscle as glycogen, reserve energy between meals.
oModerate amounts must be ingested at regular intervals to meet energy demands.
oSurplus carbohydrates stored as adipose tissue.
oRecommended Dietary Allowance (RDA): 130 g/day (55% to 60% total calories)
- Anatomy and Physiology: Macronutrients – Protein
Protein is essential for growth and repair of body tissues; also source of energy:
oTwenty different amino acids combine in a number of different ways to form
proteins.
oTen amino acids considered essential but not synthesized in body.
oFoods containing complete proteins include meat, fish, poultry, milk, and eggs.
oFoods containing incomplete proteins include cereals, legumes, and some
vegetables.
- Scientific Knowledge Base: Principles of Nutrition (Cont.)
Fats
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Chapter 35 Nutrition

  • Scientific Knowledge Base: Principles of Nutrition  Carbohydrates o Starches and sugars o Fiber (soluble or insoluble)  Proteins o Amino acids o Nitrogen balance (positive or negative)
  • Anatomy and Physiology: Macronutrients – Carbohydrates  Carbohydrates = Main source of energy and fiber: o One gram of carbohydrate produces 4 kilocalories (kcal) of energy. o Fiber provides bulk that stimulates peristalsis. o Main sources are plant foods and lactose. o Some stored in liver and muscle as glycogen, reserve energy between meals. o Moderate amounts must be ingested at regular intervals to meet energy demands. o Surplus carbohydrates stored as adipose tissue. o Recommended Dietary Allowance (RDA): 130 g/day (55% to 60% total calories)
  • Anatomy and Physiology: Macronutrients – Protein  Protein is essential for growth and repair of body tissues; also source of energy: o Twenty different amino acids combine in a number of different ways to form proteins. o Ten amino acids considered essential but not synthesized in body. o Foods containing complete proteins include meat, fish, poultry, milk, and eggs. o Foods containing incomplete proteins include cereals, legumes, and some vegetables.
  • Scientific Knowledge Base: Principles of Nutrition (Cont.)  Fats

o Types: saturated, unsaturated, monounsaturated, polyunsaturated, and essential fatty acids  Vitamins o Free radicals o Water soluble or fat soluble

  • Anatomy and Physiology: Macronutrients – Fat  Fat is main source of fatty acids and is essential for normal growth and development: o Functions of fat include: Synthesis and regulation of certain hormones, tissue structure, nerve impulse transmission, energy, insulation, and protection of vital organs. o Two essential fatty acids for metabolic processes are linoleic (or omega 6) and linolenic (or omega 3). o Fat is body’s major form of stored energy. o One gram of fat produces 9 kcal of energy.
  • Anatomy and Physiology: Macronutrients - Fat (contd.)  Gluconeogenesis process converts fat to glucose if energy needs exceed carbohydrate intake.  If more fat is ingested than needed, it is stored in adipose tissue.  RDA for fat intake: o Limit saturated fatty acid intake to less than 7% of total calories. o Limit dietary cholesterol to less than 300 mg per day.
  • Scientific Knowledge Base: Principles of Nutrition (Cont.)  Minerals o Macrominerals, microminerals, or trace elements  Water o Transports nutrients and waste products o Provides a structure to large molecules o Promotes metabolic reactions o Serves as a solvent, lubricant, and cushion o Regulates body temperature o Maintains blood volume
  • Anatomy and Physiology: Micronutrients – Vitamins  Micronutrients are required in small quantities.  Two groups—vitamins and minerals—are essential for growth and metabolic processes that occur continuously.  Vitamins classified as water- or fat-soluble. o Water-soluble vitamins cannot be stored in body; must be ingested in diet daily. o Fat-soluble vitamins can be stored in body, and vitamin toxicity can result if taken in large quantity.
  • Anatomy and Physiology: Water  Water composes 60% to 70% of total body weight. o Critical component for cellular function. o Constant loss requires replacement for survival. o 2.5 to 3 L metabolized daily in foods and fluids.

o Metabolic and lifestyle factors  Body mass index (BMI) o Recommended range: 18.5 to 24. o Overweight: 24. o Obese: 29.  Childhood obesity

  • Critical Thinking  Knowledge o Nutritional principles o Basic and social sciences  Experience o Personal and clinical  Attitudes o Integrity, discipline, and perseverance  Standards o DRIs, the USDA’s MyPlate, dietary guidelines, and Healthy People 2020 objectives, other professional standards
  • Nursing Process: Assessment  Nutritional screening tools include objective measures, including: o Height o Weight o Weight change o Primary diagnosis o Comorbidities  Outpatient screening tools o Subjective Global Assessment (SGA)
  • Nursing Process: Assessment (Cont.)  Nutritional assessment o Diet history o Medication history  Screening o Part of the initial assessment o Malnutrition Universal Screening Tool (MUST)  Older-adult considerations o Mini Nutritional Assessment (MNA)
  • Health History  Ask patient questions to elicit information about: o Current health status o Past medical history o Family history o Risk factors  Ask specific questions to assess patient’s actual or potential nutritional needs.  Use data to evaluate adequacy of diet and identify needs for patient education.
  • General Health History: Present Health Status  Do you have any chronic illnesses?  What medications do you take?  Do you take vitamins or dietary supplements?  Have you noticed any unexplained weight changes?
  • General Health History: Past Medical History and Family History  What concerns have you had regarding weight or eating problems? o What measures did you take to correct these problems?  Has anyone in your family had nutrition-related problems such as obesity or diabetes?  Have you or anyone in your family suffered from an eating disorder such as: o Bulimia nervosa? o Anorexia nervosa?
  • General Health History: Personal and Psychosocial History  Describe your activity level. o Do you exercise regularly?  Do you have any food intolerances or allergies?  Do you have problems obtaining or preparing food? o Assess support systems.  Do you use street drugs or alcohol? o Alcohol impairs nutrient absorption. o Money needed for food may be spent on drugs.
  • Nursing Process: Assessment (Cont.)  Patients at risk for nutritional problems  Physical examination  Anthropometry  Laboratory values  Dysphagia o Dysphagia screening  Patient expectations
  • Problem-Based History: Difficulty Chewing or Swallowing  What problems are you experiencing with chewing or swallowing (or both)? o When did this start?  What types of foods cause most problems eating?  What types of foods are you able to consume without difficulty?  Has your weight changed since this problem developed?
  • Examination: Routine Techniques  Measure height and weight for body mass index (BMI).  Assess general appearance and level of orientation: o Well-nourished individual is alert; body is well proportioned and within acceptable weight range.  Inspect skin for surface characteristics, hydration, and lesions: o Skin should be smooth, elastic, and without lesions, cracks, or bruising.
  • Examination: Routine Techniques (contd.)  Inspect hair and nails for appearance and texture.

o Displacement

  • Providing Parenteral Nutrition  Increased risk of infection  Solution is formulated to each patient’s needs  Need for PN is evaluated daily  Central PN o PN solutions that contain 10% dextrose or greater o Administered through a central venous catheter  Peripheral PN o PN solutions with osmolality <900 mOsm o Administered through peripheral veins
  • Providing Parenteral Nutrition (Cont.)  Initiating PN  Patient care o Preventing infection o Maintaining the PN system o Preventing complications o Meeting nutritional and fluid needs o Evaluating continued need for PN o Planning for home PN o Providing support
  • Restorative and Continuing Care  Diet therapy in disease management o Medical nutrition therapy  Home care o Education o Assessment o Troubleshooting and problem prevention o Help patient transition to oral intake when indicated
  • Nursing Process: Evaluation  Patient care o Compare patient data to expected outcomes. o Reassess the patient and revise goals as needed.  Patient expectations o Individualize the nutrition care plan and focus on the patient. o Allow the patient to make informed choices.
  • Safety Guidelines  Label enteral equipment.  Ensure “right patient, right formula, right tube”  Label enteral equipment  Elevate the head of the bed a minimum of 30 to 45 degrees.  Trace all lines and tubing back to patient.  Monitor tube placement.
  • Safety Guidelines (Cont.)  Promote food safety.  Refer to manufacturer guidelines to determine hang time for enteral feedings.  Prevent clogging  Medications administered via the feeding tube should be in liquid form whenever possible or well crushed and adequately diluted.  Administer continuous EN and PN with an infusion pump.