Chapter 35

Nutrition

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Physiology of Nutrition

Nutrition is the process by which the body metabolizes and utilizes the nutrients from food.

Nutrients are digested, absorbed by the blood or lymphatic system, and transported to the body’s cells.

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Physiology of Nutrition

Digestion is the process by which ingested foods are broken down in the GI tract to smaller segments in preparation for absorption.

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Physiology of Nutrition

Absorption is the process by which the end products of digestion pass through the epithelial membranes in the small and large intestines into the blood or lymph systems.

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Physiology of Nutrition

The end products of digestion are monosaccharides (simple sugars), amino acids, glycerol, fatty acid chains, vitamins, minerals, and water.

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Physiology of Nutrition

Metabolism is the aggregate of all chemical reactions and process in every body cell, such as growth, generation of energy, elimination of wastes, and other bodily functions as they relate to the distribution of nutrients in the blood after digestion.

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Physiology of Nutrition

Metabolic rate refers to the rate of heat liberation during chemical reactions.

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Metabolism

Energy• A calorie is the unit of measurement used to

express the quantity of energy released during metabolism.

• Energy is expressed in terms of kilocalories.• Basal metabolic rate (BMR) represents the

energy needed to maintain essential physiological functions.

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Metabolism

Excretion• Digestive and metabolic waste products are

excreted through the intestines and rectum.• Other excretory organs are the kidneys,

sweat glands, skin, and lungs.

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Nutrients

Water Vitamins Minerals Carbohydrates Proteins Lipids

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Nutrients

Water• Accounts for 60% to 70% of an adult’s total

body weight and 77% of an infant’s weight.• Water and electrolytes are substances that

must be acquired from the diet.• Body water requirements are met through

consumption of liquids and foods and the oxidation of food.

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Nutrients

Vitamins• Organic compounds that aid in the

regulation of cellular metabolism and assist in the biochemical processes that release energy from digest food

• Vitamins are classified as fat-soluble or water-soluble.

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Nutrients

Minerals• Serve as catalysts in biochemical reactions.• Classified according to daily requirement:

- Macrominerals (quantities of 100mg or greater)- Microminerals (trace elements, quantities less

than 100 mg)

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Nutrients

Carbohydrates• Organic compounds composed of carbon,

hydrogen, and oxygen• Primary source of energy for the brain and

the preferred fuel for the body

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Nutrients

Carbohydrates• Monosaccharides (simple sugars) include

glucose, galactose, and fructose.• Disaccharides (double sugars) include

sucrose, lactose, and maltose.• Polysaccharides (complex sugars) include

glycogen, cellulose (fiber), and starch.

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Nutrients

Proteins• Organic compounds that contain carbon,

hydrogen, oxygen, and nitrogen atoms• Essential for almost every bodily function

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Nutrients

The end products of protein digestion are amino acids.

Nonessential amino acids can be synthesized in the cells.

Essential amino acids must be ingested in the diet because they cannot be synthesized in the body.

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Nutrients

Proteins are also classified as complete or incomplete.• High-biological-value proteins (complete

proteins) contain all the essential amino acids.

• Low-biological-value proteins (incomplete proteins) lack one or more essential amino acid.

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Nutrients

Protein Deamination is the process of removal of (degradation) amino groups from the amino acids.

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Nutrients

Other physiological processes occur during protein deamination.• Gluconeogenesis• Ketogenesis• Nitrogen balance• Positive nitrogen balance• Negative nitrogen balance• Obligatory loss of proteins

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Nutrients

Lipids (fats) • Organic compounds are the only essential

nutrients that cannot mix with water and therefore, must be emulsified by molecules to be absorbed.

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Nutrients

Fatty Acids • Simplest form of lipids and the basic components of

more complex lipids• Saturated fatty acids form fats, which are glycerol

esters of organic acids whose carbon atoms are joined by single bonds.

• Unsaturated fatty acids form glycerol esters of organic acids whose carbon atoms are joined by double or triple bonds.

Monounsaturated Fatty Acids Polyunsaturated Fatty Acids

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Nutrients

Fatty Acids• Monounsaturated fatty acids are formed

esters with one double or triple bond.• Polyunsaturated fatty acids form esters that

have many carbons unbonded to hydrogen atoms.

• Hydrogenated or trans-fatty acids are another category of fat that is not naturally occurring but man made.

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Nutrients

Most Important Lipids• Triglycerides are composed of three fatty

acid cells attached to a glycerol molecule.• Phospholipids are composed of one or more

fatty acid molecules and one phosphoric acid radical; they usually contain a nitrogenous base.

• Cholesterol is produced by the body and is considered a fat; it is also found in whole milk and egg yolk.

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Promoting Proper Nutrition

Recommended Daily Allowances (RDAs) The Food Guide Pyramid outlines six

groups of food and the number of servings based on dietary guidelines and the basic four food groups.

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Promoting Proper Nutrition

Societal Concerns• One-third of the U.S. population is

considered overweight.• Obesity is becoming an epidemic.• Undernutrition is a specific problem for the

elderly and for people with eating disorders.

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Weight Management

Overweight is an energy imbalance in which more food is consumed than needed.

An underweight person expends more calories than are consumed.

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Weight Management

Anorexia nervosa (self-starvation) disrupts metabolism because of inadequate calorie intake.

Bulimia nervosa refers to food-gorging binges followed by purging of food, usually through self-induced vomiting or laxative abuse.

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Factors Affecting Nutrition

Age Lifestyle Ethnicity, Culture, and Religious

Practices Economics Gender

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Assessment

Nutritional History• 24-hour recall• Food-frequency questionnaire• Food record• Diet history

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Assessment

Physical Examination• Intake and Output (I & O)• Anthropometric Measurements

- Skinfold measurements- Mid-upper-arm circumference- Abdominal-girth measurement

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Assessment

Measuring the mid-upper-arm circumference

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Diagnostic and Laboratory Data

Protein Indices Serum Albumin Pre-albumin Serum Transferrin

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Diagnostic and Laboratory Data

Hemoglobin Level Total Lymphocyte Count Nitrogen Balance Urine Creatinine Excretion

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Nursing Diagnoses

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: More Than Body Requirements or Risk for More Than Body Requirements

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Other Nursing Diagnoses

Activity Intolerance Acute Pain Ineffective Health Maintenance High Risk for Impaired Skin Integrity Constipation Impaired Swallowing

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Outcome Identification and Planning

Expected outcomes are formulated to promote optimal nutritional care.

In the planning phase, the nurse identifies dietary needs and explains the need for and basis of therapy.

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Implementation

Monitoring Weight and Intake Diet Therapy

• Nothing by Mouth (NPO)• Clear-Liquid • Liquid • Soft • Mechanical Soft • Pureed

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Implementation

Diet Therapy• Low-residue • High-fiber • Liberal bland • Fat-controlled • Sodium-restricted • Lactose intolerance

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Implementation

Assistance with Feeding Providing Nutrition Support Nutrition Support Teams

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Implementation

Providing Enteral Nutrition• Feeding tubes• Insertion of enteral feeding tubes• Enteral formulas

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Enteral Feeding Routes

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Implementation

Administration of Enteral Feedings• Safety considerations• Potential complications• Removal of a nasogastric tube

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Implementation

Providing Parenteral Nutrition (PN)• Intravenous infusion of a solution directly

into a vein to meet the client’s daily nutritional requirements

• Used to treat malnourished clients or clients who have the potential for becoming malnourished and who are not candidates for enteral support.

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Implementation

Components of Parenteral Nutrition• Carbohydrates found primarily in form of

dextrose• Amino acids• Lipids (fat emulsions)

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Implementation

Administering Medication through a Feeding Tube• Types of feeding tubes• Checking for tube placement• Clearing the tubing of formula• Checking the patency of tube• Flushing the port• Measuring intake and output

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Implementation

Complementary Therapy• Nutrition is integrated as part of the

therapeutic regimen of numerous types of complementary therapies.

• Diet and nutrition are used by many alternative modalities for the prevention and treatment of chronic diseases.

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Evaluation

Current data is used to measure achievement of goals and outcomes.

The plan of care is modified to maximize the client’s response to therapy.