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Patient's Nutritional Needs

# Patient's Nutritional Needs

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05/09/2014

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Care of the Patient's
Nutritional Needs
1.
A balanced diet should consist of the following:
a.
fats
b.
proteins
c.
carbohydrates
d.
water
e.
vitamins
f.
minerals
2.
The 1990 recommendations by the United States Department of Agriculture (USDA) and Department of Health and Human Services (DHHS) for food choices that promotethe health of and prevent certain diseases in Americans include the following:
a.
eat a variety of food
b.
maintain a healthy body weight
c.
eat a diet low in fat, saturated fat, and cholesterol
d.
eat plenty of vegetables, fruits, and grain products
e.
use sugars in moderation
f.
use salt and sodium in moderation
g.
if you drink alcohol, do so in moderation
3.
Determining an estimate of the amount of energy provided in a food
a.
measured in kilocalories
i.
the amount of heat required to raise the temperature of 1000 grams of water 1 degree Celsius
b.
calculation of the kilocalories in a food:
i.
1 gram carbohydrate = 4 kilocalories/gram
ii.
1 gram protein = 4 kilocalories/gram
iii.
1 gram fat = 9 kilocalories/gram
4.
Determining an estimate of the ideal body weight (IBW) for an individual
a.
calculation of the IBW for women:
i.
for 5 feet, consider 100 pounds a reasonable weight
ii.
for each inch over 5 feet, add 5 pounds
iii.
for each inch under 5 feet, subtract 5 pounds
iv.
add 10 pounds for a large-framed individual
v.
subtract 10 pounds for a small-framed individual
b.
calculation of IBW for men:
i.
for 5 feet, consider 106 pounds a reasonable weight
ii.
for each inch over 5 feet, add 6 pounds
iii.
for each inch under 5 feet, subtract 6 pounds
iv.
add 10 pounds for a large-framed individual
v.
subtract 10 pounds for a small-framed individual
5.
Determining an estimate of the daily energy needs for an individual
a.
first, determine the individual
s basal metabolic rate (BMR)
i.
the energy required to carry out involuntary activities of the body at rest and in a fasting state
ii.
calculation of the BMR:
a.
women: BMR = 0.9 kilocalories x weight (in kilograms) x 24 (hours in a day)
b.
men: BMR = 1.0 kilocalories x weight (in kilograms) x 24 (hours in a day)
iii.
factors that increase the BMR:
a.
lean body tissue, childhood growth periods, exercise, sympathetic stimulation, shivering, fever (7% for every degree above 98.6 ), thyroid hormone,pregnancy, stress, male sex hormone
iv.
factors that decrease the BMR:
a.
fat tissue, aging process, end-stage illness, dieting, starvation, sleep
b.
second, determine the individual
s thermal effect of food (TEF)
i.
the energy the body uses in the processes of digestion and absorption
ii.
calculation of the TEF:
a.
men and women: TEF = 10% of the total kilocalories in food consumed
c.
third, calculate the individual
s physical activity energy cost (PAEC)
i.
the energy the body uses in the processes of physical activity
ii.
calculation of the PAEC:
a.
for men and women who have a sedentary lifestyle:
iii.
PAEC = 20% of the BMR
1.
e.g., typing, writing, playing cards
1.
for men and women who have a very lightly active lifestyle: PAEC = 30% of the BMR
1.
e.g., walking on a level surface at 2 - 3 mph, making beds, painting
2.
for men and women who have a moderately active lifestyle: PAEC = 40% of the BMR
1.
e.g., walking on a level surface 3.5 - 4 mph, pulling weeds, golfing (no cart)
3.
for men and women who have a heavily active lifestyle: PAEC = 50% of the BMR
1.
e.g., shoveling snow, cross-country skiing, jogging 5 mph
d.
fourth, calculate the individual
s total energy output (TEO)
i.
the sum of the body
s three uses of energy: basal metabolic rate (BMR), thermal effect of food (TEF), and physical activity energy cost (PAEC)
ii.
calculation of the TEO:
a.
for men and women: TEO = BMR + TEF + PAEC
e.
example of calculation of the TEO for a woman who has the following characteristics:
i.
weighs 130 lbs (59 kilograms)
a.
BMR = 0.9 x 59 x 24 = 1274 kilocalories

ii.
eats 1800 kilocalories a day
a.
TEF = 1800 x 10% = 180 kilocalories
iii.
maintains a regular exercise program
a.
PAEC = BMR x 40% = 510 kilocalories
iv.
TEO = 1274 + 180 + 510, or 1964 kilocalories
6.
Determining an estimate of the kilocalorie adjustment necessary for weight loss
a.
calculation of the amount of kilocalories in 1 gram of pure fat and body fat:
i.
1 gram of pure fat = 9 kilocalories
ii.
1 gram of body fat = 7.7 kilocalories (some water in body fat cells)
b.
calculation of the amount of kilocalories in 1 pound of pure fat and body fat:
i.
1 pound of pure fat = 454 grams x 9 kilocalories/gram = 4086 kilocalories
ii.
1 pound of body fat = 454 grams x 7.7 kilocalories/gram = 3496 kilocalories
c.
calculation of the amount of kilocalorie adjustment necessary to loss one pound (3500 kilocalories) of body fat per week
i.
3,500 kilocalories 7 days (1 week) = 500 kilocalories/day
7.
Carbohydrates
a.
organic compounds composed of three elements:
i.
carbon (C), hydrogen (H), oxygen (O)
b.
significance of carbohydrates
i.
provide an immediate and reserve source of energy at 4 kcal/gm
ii.
spare protein from being used as a source of energy so that it can be used for other functions
iii.
prevents ketosis as a result of inefficient fat metabolism for energy
c.
percentage in the diet
i.
composes 45% of the total kilocalories in the average American diet
ii.
should compose 55% to 60% of the total kilocalories in the average American diet
d.
classification of carbohydrates (monosaccharides and disaccharides)
i.
simple sugars
a.
monosaccharides
1.
composed of a single sugar molecule
2.
the three monosaccharides are:
a.
glucose (dextrose), fructose, galactose
3.
sources:
a.
glucose
i.
corn syrup
b.
fructose
i.
fruits, honey
c.
galactose
i.
milk
b.
disaccharides
1.
composed of two sugar molecules
2.
the three disaccharides are:
a.
maltose (glucose + glucose)
b.
sucrose (glucose + fructose)
c.
lactose (glucose + galactose)
3.
sources:
a.
maltose
i.
sweetners in food products, intermediate and final starch digestion
b.
sucrose
i.
table sugar, sugar cane, sugar beets, molasses
c.
lactose
i.
milk
ii.
complex sugars (polysaccharides; starch and fiber)
a.
starch
1.
long chain of hundreds of sugars derived from plants that are linked together by bonds that human digestive enzymes can break
2.
sources:
a.
grains and grain products, legumes, potatoes
b.
fibers (cellulose, hemicellulose, gums, mucilages)
1.
long chain of hundreds of sugars derived from plant cell walls that are linked together by bonds that human digestive enzymes cannot break
2.
sources:
a.
stems and leaves of vegetables, coverings of seeds and grains, algae, seaweed
e.
carbohydrate metabolism
i.
storage and conversion
a.
carbohydrates are stored primarily in the liver and skeletal muscle as glycogen (a large polymer of glucose) through the process of glycogenesis(formation of new glycogen) to remove excess glucose out of the bloodstream while maintaining a blood glucose level of 70 - 120 mg/dl
b.
when the blood glucose level drops below 70 -120 mg/dl, glycogen stores in the liver and skeletal muscle are converted back to glucose through theprocess of glycogenolysis (breakdown of glycogen into glucose)
c.
if glycogen stores are depleted, proteins and fats are converted in the liver to glucose through the process of gluconeogenesis (creation of a newglucose)
ii.
energy production
a.
each glucose molecule is broken down into two molecules of pyruvic acid (glycolysis)
b.
pyruvic acid is then converted into two molecules of acetyl coenzyme A (acetyl - CoA)
c.
each acetyl - CoA molecule is split in the citric acid cycle (Krebs cycle) and its energy is donated to energy storage compounds (adenosinetriphosphate - ATP)
f.
carbohydrate digestion
i.
simple sugars (monosaccharides)
a.
require no digestion; quickly absorbed from the intestine and transported to the liver
ii.
simple sugars (disaccharides)
a.
require digestion; quickly absorbed from the intestine and transported to the liver only after being digested by a series of enzymes to simple sugars

b.
mouth
1.
ptyalin
a.
starch dextrins maltose
c.
pancreas
1.
pancreatic amylopsin
a.
starch dextrins maltose
d.
small intestine
1.
sucrase
a.
sucrose glucose + fructose
2.
lactase
a.
lactose glucose + galactose
3.
maltase
a.
maltose glucose + glucose
iii.
complex sugars (polysaccharides)
a.
starch
1.
require digestion; absorbed from the intestine and transported to the liver only after being digested by a series of enzymes in the same way asdisaccharides to simple sugars
b.
fibers (cellulose, hemicellulose, gums, mucilages)
1.
are never digested
8.
Protein
a.
organic substances composed of four elements:
i.
carbon (C), hydrogen (H), oxygen (O), nitrogen (N)
b.
significance of proteins
i.
essential for tissue growth and repair
ii.
component of the body framework and fluids
iii.
help regulate fluid and acid-base balance
iv.
form antibodies
v.
provide a source of energy when carbohydrate intake is low at 4 kcal/gm
c.
percentage in the diet
i.
composes about 15% of the total kilocalories in the average American diet
ii.
should compose about 15% of the total kilocalories in the average American diet
d.
classification of proteins
i.
essential or nonessential amino acids
a.
essential amino acids
1.
proteins that the body cannot manufacture and, therefore, must be supplied for the body as part of the diet
2.
the nine essential amino acids are:
a.
threonine, leucine, isoleucine, valine, lysine, methionine, phenylalanine, tryptophan, histidine
b.
nonessential amino acids
1.
proteins that the body can manufacture and, therefore, do not need to be supplied as part of the diet
2.
the twelve nonessential amino acids are:
a.
glycine, alanine, aspargine, aspartic acid, glutamic acid, glutamine, proline, hydroxylysine, hydroxyproline, cytine, tyrosine, and serine
ii.
complete or incomplete amino acids
a.
complete
1.
contain all the essential amino acids and many nonessential ones
2.
sources:
a.
meats, poultry, fish, dairy products, eggs
b.
incomplete
1.
lack one or more of the essential amino acids
2.
sources:
a.
grains, legumes, vegetables
iii.
complementary amino acids
a.
two or more proteins whose amino acid assortments complement each other in such a way that the essential amino acids missing from each aresupplied by the other
b.
a person should select from two or more of the following groupings to create complimentary amino acid combinations:
1.
grains
a.
e.g., oats, rice, whole grain breads, pasta
2.
legumes
a.
e.g., peanuts, soy products, pinto beans, black beans
3.
seeds and nuts
a.
e.g., cashews, nut butters, sesame seeds
4.
vegetables
a.
e.g., broccoli, cabbage, peppers, squash, spinach
e.
protein metabolism
i.
storage
a.
as plasma proteins
1.
e.g., albumin, globulin, fibrinogen
b.
as body tissue
1.
e.g., any body tissue or cell
ii.
anabolism
a.
synthesis of tissue proteins from amino acids
iii.
catabolism
a.
breakdown of the body
s tissue proteins to amino acids in the liver in the following way:
1.
removing the nitrogen-containing amino part of the amino acid through the process of deamination and either:
a.
converting it to ammonia to be excreted as urea in the urine
b.
using it to make another compound, such as a nonessential amino acid
2.
converting the remaining non-nitrogen containing part of the amino acid to either:
a.
pyruvic acid, which can be converted to glucose