NUTRITION

Nursing Implications

Ilkafah, M.Kep

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 Nutrition

• All of the processes involved in consuming

and utilizing food for energy, maintenance,
and growth.
 Physiology of Nutrition

Five processes are involved in the body’s use of

nutrients:
– Ingestion.
– Digestion.
– Absorption.
– Metabolism.
– Excretion.
 Ingestion

• The taking of food into the digestive tract,

generally through the mouth.
 Digestion

• The mechanical and chemical processes that

convert nutrients into a physically absorbable
state. Digestion includes:
– Mastication (chewing).
– Deglutition (swallowing).
– Peristalsis (coordinated, rhythmic, serial contractions
of the smooth muscles of the GI tract).
 Absorption

• The process by which the end products of

digestion pass through the small and large
intestines into the blood or lymph systems.
 Metabolism

– The body’s conversion of nutrients into

energy.

– Basal metabolism is the amount of energy

needed to maintain essential physiologic
functions when a person is at complete
rest, both physically and mentally.
 Excretion

– The process of eliminating or removing

waste products from the body.
 The Six Essential Nutrients

• Water
• Carbohydrates
• Fats
• Proteins
• Vitamins
• Minerals
 Water

• The Most Important Nutrient.

• Daily requirements: 1,000mL of water to

process 1,000kcal eaten.
 Functions of Water

• Solvent (dissolves • Lubricant (aids in providing

substances to smooth movement for
form solutions). joints).
• Transporter (carries • Component of all cells.
nutrients, wastes, etc.
throughout the body).
• Hydrolysis (breaks apart
substances, especially
• Regulator of body in metabolism).
temperature.
 Classification & Sources
of Water

• Liquids consumed (water, coffee, juice, tea,

milk, soft drinks).
• Foods consumed (especially fruits and
vegetables).
• Metabolism (produces water
when oxidization occurs).
Water: Digestion, Absorption and
Storage

• Water is not digested. It is absorbed and used by

the body as we drink it. It cannot be stored by
the body. The body loses water in four ways:
– Urine.
– Feces.
– Perspiration.
– Respiration.
 Water: Signs of Deficiency

• Abnormal water losses include profuse

sweating, vomiting, diarrhea, hemorrhage,
wound drainage (burns), fever, and edema.
• A deficiency of water is called dehydration.
Prolonged dehydration results in death.
 Carbohydrates

• The chief source of energy for the body.

Made up of carbon, hydrogen, and oxygen.
They are the major source of food for all
people.

• Daily requirements: 50% to 60 of

an individual’s kcal intake per day.
 Functions of Carbohydrates

Carbohydrates are...
• The primary source of energy for the body.
• Spares proteins from being used for energy, thus allowing
them to perform their primary function of building and
repairing body tissues.
• Needed to oxidize fats completely and for synthesis of
fatty acids and amino acids.
 Carbohydrates: Classification and
Sources

• Carbohydrates may be simple or complex.

• Simple are single or double sugars.
• Complex are composed of many single
sugars joined together (starch, dietary fiber,
glycogen).
Carbohydrates: Digestion, Absorption
and Storage

• Digestion of cooked starches begins in the

mouth.
• Little digestion occurs in the stomach.
• Carbohydrate digestion completed in the
small intestine.
• Carbohydrates are used completely, leaving
no waste for the kidneys to excrete.
Carbohydrates: Signs of Deficiency

• Mild deficiency can result in weight loss

and fatigue.
• Serious deficiency can result in ketosis.
 Fats

• The most concentrated source of energy in

the diet. An essential nutrient, but too much
can be a health hazard.
• Daily requirements: should not exceed
25% to 30% of an individual’s caloric intake
per day.
 Functions of Fats

• Provides concentrated source of energy.

• Assists in absorption of fat-soluble vitamins.
• Is a major component of cell membranes and myellin
sheaths.
• Improves flavor of foods and delay’s stomach’s emptying
time.
• Protects and hold organs in place.
• Insulates body, thus assisting in temperature maintenance.
 Classification of Fats

• Triglycerides (true fats).

• Phospholipids (lipoids, composed of glycerol,

fatty acids, and phosphorus).

• Cholesterol.
 Sources of Fats

• Animal (lard, butter, milk, cream, egg yolks,

and fat in meat, poultry, and fish).

• Plant (oils from corn, safflower, peanut, palm,

etc., as well as nuts and avocado).
Digestion, Absorption and Storage of
Fats

• No chemical breakdown of fats occurs in the

mouth and very little in the stomach.

• Digestion occurs in small intestine.

• Fats not immediately needed by the body

are stored as adipose tissue.
Fats: Signs of Deficiency and Excess

• Deficiency occurs when fats provide less than

10% of daily kcal requirement.
• Gross deficiency may result in
eczema, retarded growth, and weight
loss.
• Excess fat consumption can lead to
overweight and heart disease.
 Proteins

• The only nutrient that can build, repair,

and maintain body tissues.
• Daily requirements: determined by size, age,
gender, and physical and emotional conditions.
• Daily protein requirement for average
adults is 0.8g for each kilogram of weight.
 Functions of Proteins

• To provide amino acids necessary for synthesis of body

proteins, used to build, repair, and maintain body tissues.
• To assist in regulating fluid balance.
• Used to build antibodies.
• Plasma proteins help control water balance between the
circulatory system and surrounding tissues.
• In event of insufficient stores of carbohydrates and fats,
protein can be converted into glucose and used for energy.
Classification & Sources of Proteins

• Complete proteins contain all 9 essential

amino acids. (All animal fats, except for
gelatin, are complete. Only plant fat that is
complete is soybeans).

• Incomplete proteins have one or more

essential amino acids missing (plant
proteins).
Digestion, Absorption and Storage of
Protein

• Digestion begins in the stomach.

• Most digestion takes place in the
small intestine.
• Amino acids not used to build proteins are
converted to glucose, glycogen, or fat and are
stored.
 Signs of Deficiency and Excess of
Protein

• Muscle wasting.
• Edema (swelling).
• Lethargy and depression.
• Excess can result in heart disease,
colon cancer, osteoporosis.
 Vitamins

• Essential organic compounds that regulate

body processes and are required for
metabolism of fats, proteins, and
carbohydrates.

• Needed in very small amounts.

 BODY WEIGHT/BODY MASS
• Ideal body weight
• Body mass index
• Percent body fat

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 FACTORS AFFECTING NUTRITION
• Development
• Gender
• Ethnicity & culture
• Beliefs about food
• Personal preferences
• Religious practices
• Lifestyle
• Medications & therapy – table 45-1

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• Health
• Alcohol abuse
• Advertising
• Psychologic factors
 NUTRITION THRU THE
LIFE CYCLE – Young & Middle Adult
• Lay foundation for lifetime nutrition pattern in young
adulthood
• Nutrient requirements change very little
• Females need to maintain/increase intake of Vit. C
, Vit D, & calcium; & maintain intake of iron
• Basal metabolism decreases 2-3%/decade after
age 25
• Obesity, HTN , & DM may begin to form

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 NUTRITION THRU THE
LIFE CYCLE – Older Adults
• Physiologic, psychosocial, economic changes
• Need fewer calories
• Nutrient requirements basically the same
• Variety & nutrient dense foods; water

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 Factors Affecting Nutrition:
Ethnicity & Culture
• Native American
– Starches: corn, rice
– Fruits: berries
– Veggies: rhubarb, mushrooms, roots
– Meats: game, seafood, nuts
– Milk: little used
• High incidence of lactose intolerance
• Encourage broiled, poached, steamed meats

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• U.S. Southern
– Starches: cornbread, biscuits, potatoes
– Fruits: melons, peaches, bananas
– Veggies: collards, okra, tomatoes, cabbage
– Meat: pork, chicken, fish
– Milk: milk, ice cream
• Many foods fried, cooked with lard
 Factors Affecting Nutrition:
Ethnicity & Culture
• Mexican
– Starches: tortillas, corn products
– Fruits: few
– Veggies: chili peppers, tomatoes, onions
– Meat: beef, poultry, eggs, pinto beans
– Milk: cheese; rarely drink milk

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 Beliefs & Preferences
• Individual likes & dislikes
• Beliefs about foods
• Fad diets
 Religious Practices
• Christianity
– Catholics
– Eastern Orthodox
– Mormons
– Seventh Day Adventists
• Islam
– No pork or alcohol; daylight fasting during Ramadan
 Lifestyle
• Economic & social status
• Work/activities
 Medications, Therapy, & Health

• Therapies
– Chemo, radiation
• Health
– GI disorders, viruses, oral ulcers
 Alcohol, Advertising, & Psych
• Alcohol
– Can depress appetite
– Abuse can lead to malnutrition (esp Vit B)
• Advertising
– May influence food choices
• Psych
– Overeat vs. don’t eat when stressed, depressed
 DIETARY GUIDELINES
• Eat a variety of foods
• Maintain or improve your weight
• Be physically active every day
• Eat diet low in trans fat, saturated fat, & cholesterol
• Eat plenty of vegetables, fruits, & grains
• Use sugars in moderation
• Use salt & sodium in moderation
• If you drink alcohol, do so in moderation

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Pyramid Food Guide
The MyPyramid.gov Food Guide. (Source: U.S. Department of Agriculture. [2008]. Available at www.mypyramid.gov.) dalam Fundamental of
Nursing Ed 7 (carol R. Taylor, 2011)
Food Guide Pyramid
Fats, oils & sweets
Use sparingly
Milk, Yogurt & Cheese
Meat, poultry, fish, dry beans, eggs & nuts
2-3 servings
Vegetables & Fruits
(2-5 servings)

Bread, cereal, rice & pasta

(6-11 servings)
 FOOD GUIDE PYRAMID

• Healthy Eating Pyramid

• Daily exercise & weight control
• Whole grains at most meals
• Vegetables in abundance
• Fruits 2-3 times/day
• Nuts, legumes 1-3 times/day
• Fish, poultry, eggs 0-2 times/day
• Dairy or calcium supplement 1-2 times/day
• White rice, white bread, potatoes, pasta, sweets, red
meat, butter sparingly
• MVI for most
• Alcohol in moderation
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 ALTERED NUTRITION
• Malnutrition – lack of necessary or
appropriate food substances
– Overnutrition – caloric intake in excess of
daily energy requirements
• Overweight – BMI 26-30
• Obese – BMI > 30
• Morbid obesity – interferes with mobility or breathing

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• Malnutrition
– Undernutrition – intake of nutrients insufficient to
meet daily energy requirements as a result of
inadequate food intake or improper digestion &
absorption of food
• Dysphagia – difficulty swallowing
• Anorexia – loss of appetite
• Protein-calorie malnutrition
 The Nursing Process: Assessment

Two types of data:

• Subjective.
• Objective.
 Subjective Data

• 24-Hour Recall.
• Food-Frequency Questionnaire.
• Food Record.
• Diet History.
 Objective Data

• Body Mass Index.

• Skinfold Measurement.
• Other Measurements (e.g. Abdominal-Girth,
Mid-Upper-Arm).
• Laboratory Tests.
 RISK FACTORS FOR NUTRITIONAL
PROBLEMS
• Diet history
– Chewing or swallowing difficulties
– Inadequate food intake
– Restricted or fad diets
– No intake for 10 or more days
– Inadequate food budget
– Inadequate food preparation facilities
– Physical disabilities
– Living & eating alone

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• Medical history
– Unintentional wt loss or gain of 10% within 6 months
– F/E imbalance
– Oral or GI surgery
– Dental problems
– GI problems
– Chronic illness
– Alcohol or substance abuse
– Neurologic or cognitive impairment
– Catabolic or hypermetabolic condition
– Adolescent pregnancy or closely spaced pregnancy
• Medication history
– Aspirin
– Antacid
– Antidepressants
– Antihypertensives
– Anti-inflammatory agents
– Antineoplastic agents
– Digitalis
– Laxatives
– Diuretics
– Potassium chloride
 PHYSICAL EXAM
• General appearance & vitality
• Weight
• Skin
• Nails
• Hair
• Eyes
• Lips, tongue, gums, teeth
• Heart
• Abdomen
• Musculoskeletal
• Neurologic
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 ANTHROPOMETRIC MEASUREMENTS
• Height & weight
• Skinfold measurements – tricep most
common site

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 LABORATORY DATA
• Albumin & pre-albumin
• Transferrin
• Hgb
• BUN
• 24 hour urine
• Total lymphocyte count

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 DIAGNOSING
• Altered nutrition: more than body requirements
• Altered nutrition: less than body requirements
• Altered nutrition: risk for more than body
requirements
• Fluid volume excess, fluid volume deficit, & risk
for fluid volume deficit
• Activity intolerance
• Constipation
• Risk for Impaired Skin Integrity

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 PLANNING
• Client will:
– Maintain I&O balance
– Consume proper amounts of foods from variety
of food groups
– Comply with diet therapy
– Tolerate tube feedings
– Not have any complications assoc with
malnutrition

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 IMPLEMENTING - Teaching
• Use established nutritional standards
• Use visualization of serving sizes to help ID
accurate serving sizes
• Incorporate culturally based intake patterns or
restrictions
• Include client & family
• Collaborate with dietician

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 IMPLEMENTING
Special Diets
• NPO – nothing by mouth
• Clear liquid diet – water, tea, coffee, clear broths,
gingerale, plain gelatin
• Full liquid diet – clears; milk; cooked
cereals, pudding, ice cream, cream soup;
• Soft diet – easily chewed & digested
• Dysphagia – thickened liquids
• Diet as tolerated

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 Stimulating Appetite
• Relieve illness symptoms that depress appetite
prior to mealtime
• Provide familiar food that person likes served
at proper temp.
• Select small portions
• Avoid unpleasant or uncomfortable treatments
or activity immediately before/after meals
• Provide tidy, clean environment
• Encourage or provide oral hygiene before mealtime
• Reduce psychologic stress
 Assisting with Meals
• Help client feed self when possible
• Assist client to sit on side of bed or chair if possible
• Check tray for client’s name, type of diet, & completeness
• “which order would you like to eat?”
• Spread napkin, cut foods, shell egg, etc.
• Do not rush client; allow ample time
• Offer fluids every 3 or 4 mouthfuls of food if client unable to
communicate
• Use adaptive feeding aids as needed
• For blind person, identify placement of food as you would
describe time on a clock
 Special Supplements
• Oral
– Provide calories & nutrients
– Can be liquid or powdered
– Specific types
• Tube Feeds
– When condition prevents food intake
– Impairment in upper GI tract, otherwise fx GI tract
– Increased metabolic needs that oral intake can’t meet
• Parenteral Nutrition
– IV nutrients (TPN, PPN)
 EVALUATING
Enteral Feeds
• Daily wt
• I&O
• Labs
• Monitor for complications

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 IMPLEMENTING
Home Care Teaching
• Preparation of formula
• Proper storage of formula
• Administration of feeding
• Mgmt of enteral or parenteral access device
• Daily monitoring needs
• S/S of complications to report
• Who to contact with questions/problems

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 EVALUATING
• If outcomes not achieved,
– Was cause of problem correctly identified?
– Was family included in teaching plan? Are they
supportive?
– Is client experiencing symptoms that cause loss of
appetite?
– Were outcomes unrealistic for this person?
– Were client’s food preferences considered?
– Is anything interfering with digestion or absorption of
nutrients?

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TERIMAKASIH