Stressors that Affect Nutrition NUR101 FALL 2010 LECTURE # 24 K. BURGER, MSED, MSN, RN, CNE PPP By Sharon Niggemeier RN MSN
Feb 08, 2016
Stressors that Affect Nutrition
NUR101FALL 2010LECTURE # 24K. BURGER, MSED, MSN, RN, CNE
PPP BySharon Niggemeier RN MSN
Nutrition• Nutrition is interaction between an
organism and the food it consumes• Food & eating is a basic need, affects
health• Various factors affect nutrition• Nutrients – substances used by the body
for growth & development• Role of nurse to teach, guide and inform
on the importance of proper nutrition
Nutritional health-care Team
• MD • Nurse• Social Worker• Physical Therapist• Occupational Therapist• Speech Pathologist• Pharmacist
Essential Nutrients Regulatory Nutrients
• Water• Carbohydrates• Proteins• Lipids
• Vitamins• Minerals
Water• Water: present in every cell• Absorbed in small /large intestine• Metabolized carbohydrates, proteins,
lipids produce water• Dietary intake from fluids and solid
food provide water• Function: fluid medium needed for all
chemical reactions in the body
Carbohydrates• Carbohydrates: simple or complex• Digested by enzymes (amylase/lactase)• Absorbed in small intestine• Metabolized into glucose which is
used for energy or stored…Stored as either glycogen or fat
• Function: provide energy, spare proteins
Carbohydrates (CHO)• Carbon – Hydrogen-Oxygen• 1 gram carbohydrate = 4 Kcal• Monosaccharides – simple sugars
glucose, fructose, galactose• Dissaccharides – double sugars
sucrose, lactose, maltose• Polysaccharides – complex forms
starch, glycogen, cellulose (fiber)• Recommended intake: 60% of total Kcal (300g)
Fiber 25-30g daily
Carbohydrates
• What are some other functions of carbohydrates in our bodies?
Laxative effects of:
LactoseCellulose
DIETARY FIBER - Helps regulate blood sugar
May reduce risk of hyperlipidemia
May reduce risk of some cancers
Protein• Proteins: composed of amino acids • Digested by enzymes (proteolytic) • Absorbed in small intestine• Metabolism includes:• Anabolism=Catabolism: Nitrogen
balance • Function: maintain body
tissue and tissue growth
Protein (CHON)• Carbon-Hydrogen-Oxygen- Nitrogen• 1 gram of protein = 4 Kcal• Comprised of 22 amino acids which can be comined by
body to form over 1000 types of proteins• 9 essential amino acids – body cannot synthesize them• Complete protein = one with all 9 essential amino acids
(animal sources and soy)• Incomplete proteins = contain some but not all essential
(plant sources)• Complementary proteins = 2 proteins that when
combined provide all essential amino acids.• Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)
Proteins (CHON)
• What are some other functions of proteins?
Fluid Balance
Ex: Albumin
Energy ( last resort)De-amination / Nitrogen stripped from CHON to create glucose CHO
Lipids• Lipids: insoluble in water• Digested by enzymes (lipase,bile) in
stomach and small intestine• Absorbed in small intestine• Metabolism includes conversion (by
liver and small intestine) into soluble compounds called lipoproteins
• Function: energy, insulates body, absorption (fat-soluble vitamins)
Lipids (Fats)• Carbon-Hydrogen-Oxygen• 1 gram of Fat = 9 Kcal• Composed of fatty acids: (linoleic&linolenic =essential)
• Saturated fat = mostly animal source• Unsaturated fat = mostly plant and fish sources• Triglyceride = fat in bloodstream /storage form of fat
in body. • Trans Fat = hydrogenated fats in processed foods• Recommended intake: 20-35% of total Kcal
Lipids• Lipoproteins - made by the body to move water-
insoluble lipids (such as cholesterol) thru the bloodstream
• LDL (low density lipoprotein)- major carrier of cholesterol. Function is to transport cholesterol from liver into circulation. “Bad cholesterol”
• HDL (High density lipoprotein) - carries cholesterol away from tissue to liver ..high levels decrease atherosclerosis. “Good cholesterol”
• Cholesterol- not essential from diet as the body produces enough.
Desirable Blood Lipid Levels
• Total Cholesterol < 200• Triglycerides < 150• LDL < 100• HDL > 40 Male
> 50 Female• Elevated Blood Lipid Levels
(Hyperlipidemia) = increased risk for CHD, Hypertension, Stroke, MI
Vitamins• Vitamins: required in small amounts• water- soluble: absorbed through
intestine directly into blood stream (C, B complex folic acid)
• fat-soluble: absorbed with lipids into lymphatic circulation (A,D,E,K)
• Function: needed for metabolism of carbohydrates, lipids & proteins
Water-soluble vitamins text review
Vitamin C (ascorbic acid)• Function: collagen formation (wound
healing), antioxidant, immune system• More prone to deficiency; not stored • Deficiency: bleeding gums, scurvy,
poor wound healing• Source: citrus fruits,
tomatoes, broccoli
Vitamin B Complex : thiamine, riboflavin, niacin, B6, B12
• Function: metabolism of carbs, lipids and proteins
• RNA, DNA synthesis (folic acid) & heme formation (B12)
• Deficiency:beriberi, poor wound healing, anemia, pernicious anemia
• Sources: Whole grains Organ meats
Vitamin B12 (continued)
Vitamin B12 (cobalamine)• Important for hemoglobin synthesis• Very little found in vegetable sources (unlike other B Vitamins)
• Pernicious anemia = B12 deficiency or lack of intrinsic factor for B12 absorption.Susceptible population = Total VeganClients w/ decreased gastric acid secretion(gastric bypass, stomach cancer)
• Rx = B12 injections
Folic AcidFolic Acid (Folate)
• Folic Acid Deficiency leads to elevated Homocysteine levels which are associated with increased risk for CHD.
• Folic Acid Deficiency linked to neural tube defects – Spina Bifida
• Natural folate (in foods) only ½ as available to body as supplement folic acid
• 1998 = mandatory fortification of breads/grains• Supplements recommended for: women of child-bearing
age, gastric surgery, malabsorption (alcholic)
Fat-soluble Vitamins text review• Vitamin A: function- visual acuity, skin maintenance…
deficiency-night blindnessDark green leafy vegs, yellow/orange vegs
• Vitamin D: function-calcium absorption… deficiency-rickets, bone malformationFortified milk, ultraviolet light
• Vitamin E: function-antioxidant, heme synthesis…deficiency-RBC hemolysisWhole grains, nuts
• Vitamin K: function-formation blood clotting proteins…deficiency- hemorrhageDark green leafy vegs, synthesized by bacteria in sm intestine
• More prone to toxicity; stored by body
Minerals• Minerals: macrominerals or microminerals• Originate in earth’s crust, aren’t digested or
metabolized. Combine to form salts or organic compounds. Always retain their chemical properties.
• Function: provide structure within the body (bones/teeth, F/E and acid /base balance, nerve transmission, muscle contraction)
Macrominerals text review
• Calcium: bone/ teeth formation, blood clotting, nerve transmission…deficiency-tetany, osteoporosis
• Phosphorous: bones, acid-base balance…deficiency- muscle weakness
• Magnesium: bones, metabolism ...deficiency-muscle pain, poor cardiac function
• Potassium: f/e balance, acid-base balance… deficiency-muscle cramps , irregular ht. rate
Microminerals text review
• Iron: hemoglobin formation…deficiency-anemia
• Iodine: thyroid hormones…deficiency- goiter
• Zinc: wound healing … deficiency-impaired immune system
• Fluoride: teeth/bones…deficiency- discolored tooth enamel
Energy Balance• Kilocalorie- unit of heat; measures the
energy in the diet• Basal metabolic rate (BMR)- amount
of energy needed for all the biochemical processes to occur when the body is at rest.
• Proper nutrition provides the energy needed to maintain health
Body Weight Standards• Ideal body
weight IBW = balance of energy used by the body and intake of nutrients
• Rule of thumbWomen: 100 lbs lst 5ft
5 lbs/inch over 5ftMen: 106 lbs lst 5 ft 6 lbs/inch over 5ft
• Standardized chartsOverweight = 10% > chartObese = 20% > chart
• Body mass index(BMI) 18.5 – 24.9 healthy> 25 = overweight> 30 = obese> 40 = morbidly obese
Factors Affecting Nutrition• Developmental• Gender• Ethnicity &
culture• Food beliefs• Preference• Religion
Factors Affecting Nutrition• Lifestyle• Medications &
therapy• Heath status• Advertising• Alcohol
Consumption• Psychological
factors
Adequate Nutrition• Food Guide
Pyramid• Daily reference
intake • Food Labeling• Dietary guidelines
Food Guide Pyramidmypyramid.gov
Bread/Cereal/Rice/Pasta
6 servings
Vegetables 3-5 servings
Fruits 2-4 servings
Milk, Cheese 2-3 servings
Meat, Fish, Poultry, Nuts
2-3 servings
Fats/Oils/Sweets sparingly
Dietary Guidelines
• Balance / Moderation / Variety• Maintain healthy weight• Exercise• Eat a variety of foods in moderation• Low sodium / Low fat / Low simple sugars• Alcohol in moderation
Assessing: Nutrition• Nursing history • Physical exam• 24-hr. recall• Food records• Anthropometic data• Lab tests – Albumin & Prealbumin
Hemoglobin Transferrin
Nursing Dx• Imbalanced nutrition: less than body
requirements R/T NPO status AEB height 5’6’’ wt 105 lbs., pt. states “ I’ve never been this skinny before, my clothes are hanging off of me”
• Impaired dentition R/T nutritional deficits AEB dentures not fitting properly
Planning- outcome criteria• Pt. will:• Attain and maintain ideal body weight• Eat a variety of foods at each meal• Promote healthy nutritional practices
Interventions
• Monitoring food intake
• Assist with feeding
• Stimulate appetite• Teaching
Diet Restrictions• NPO• Clear liquids-see
through (broth, apple juice)
• Full liquids –foods that turn to liquid at room temp. (shakes, milk)
• Soft –easily chewed and digested
• Low residue- no seeds, raw vegetables or fruits, whole grains
• High fiber- raw fruits, grains, vegetables
• Sodium restricted:– Mild 2 gram Na/day– Moderate 1gram– Strict 500mg– Severe 250 mg– DASH Dietary Approaches
to Stop Hypertension
Diet Restrictions
• Calorie restrictions
• Diabetic diet
• Cholesterol
• Food textures:Thick it
• Thin• Nectar-like• Honey-like• Spoon-thick
Enteral Nutrition
• Used when oral intake is inadequate, swallowing difficulty, coma
• Tube passed into gastrointestinal tract to deliver nutrients
• Maintains GI integrity preferred over parental feedings (via veins)
Enteral Nutrition
• Short term use
• Nasogastric• Nasointestinal
• Long term use
• Gastrostomy• Percutaneous
endoscopic gastrostromy (PEG)
Enteral Formulas
• Many types of formulas• Administered continuous or
intermittent• Use pumps to monitor intake• Monitor Intake & Output
Enteral Precautions• Prevent aspiration
– Position fowlers/high fowlers– Assess placement…check pH– Note residual– Auscultate bowel sounds
Enteral Precautions• Preventing complications include:
• Clogged tube• Nasal erosion• Diarrhea• Infection• Dislodgement
Parental Nutrition
• Bypasses GI tract, nutrition administered IV, more complicated
• Total parental nutrition (TPN) also called (hyperalimentation)…central line
• Partial parental nutrition (PPN)..PICC line
Summary• Nurses role, to understand nutrients and how
they affect nutrition• Various factors affect one’s nutritional
status• Interventions include numerous diets,
assisting with feeding, monitoring and teaching
• Nutrition can also be administered enterally or parentally