NUTRITION

THERAPY
Six Classes of Nutrients
 Nutrients that supply energy
 Carbohydrates
 Protein
 Lipids
 Nutrients that regulate body processes
 Vitamins
 Minerals
 Water
Carbohydrates
 Sugars and starches
 Organic compounds composed of carbon,
hydrogen, and oxygen
 Serve as the structural framework of plants;
lactose is only animal source
 Most abundant and least expensive source of
calories in the world
 Classified as simple or complex sugars
Carbohydrates (cont.)
 90% of carbohydrate intake is ingested
 Converted to glucose for transport through the
blood
 Cells oxidize glucose to provide energy, carbon
dioxide, and water
 50 to 100 g of carbohydrates are needed daily to
prevent ketosis
Protein
 Required for the formation of all body structures
 Labeled complete (high quality) or incomplete
(low quality), based on amino acid composition
 Animal proteins are complete; plant proteins are
incomplete
 Protein tissues are in a constant state of flux
 RDA for adults is 0.8 g/kg of body weight, 10% to
20% total calorie intake
Fats
 Insoluble in water and blood
 Composed of carbon, hydrogen, and oxygen
 95% of lipids in diet are triglycerides
 Contain mixtures of saturated (raise cholesterol
levels) and unsaturated (lower cholesterol levels)
fatty acids
 Most animal fats are saturated
 Most vegetable fats are unsaturated
Fats (cont.)
 Digestion occurs largely in the small intestine
 Most concentrated source of energy in the diet
 RDA not established, should be less than 30% daily
caloric intake
Vitamins
 Organic compounds needed by the body in small amounts
 Most are active in the form of coenzymes
 Needed for metabolism of carbohydrates, protein, and fat
 Classified as water soluble or fat soluble
 Absorbed through the intestinal wall directly into bloodstream
Minerals
 Organic elements found in all body fluids and
tissues
 Some function to provide structure in body, others
help regulate body processes
 Macrominerals include calcium, phosphorus, and
magnesium
 Microminerals include iron, zinc, manganese, and
iodine
Water
 Accounts for between 50% and 60% of adult’s
total weight
 Two-thirds of body water is contained within the
cells (ICF)
 Remainder of body water is ECF, body fluids
(plasma, intersititial fluid)
 Provides fluid medium necessary for all chemical
reactions in body
 Acts as a solvent and aids digestion, absorption,
circulation, and excretion
The MyPyramid Food Guide
Factors Affecting BMR
 Males have a higher BMR due to larger muscle mass
 BMR is about 1 cal/kg of body weight per hour for men
 BMR is about 0.9 cal/kg of body weight per hour for women
 Factors that increase BMR
 Growth, infections, fever, emotional tension, extreme environmental
temperatures, elevated levels of certain hormones
 Factors that decrease BMR
 Aging, prolonged fasting, and sleep
Developmental Considerations
 Growth—infancy, adolescence, pregnancy, and
lactation increase nutritional needs
 Activity increases nutritional needs
 Age-related changes in metabolism and body
composition
 Nutritional needs level off in adulthood
 Fewer calories required in adulthood because of
decrease in BMR
NUTRITION THROUGH THE LIFE SPAN
 FETUS
 INFANCY
 TODDLER
 PRE-SCHOOL
 SCHOOL AGE
 ADOLESCENCE
 EARLY ADULTHOOD
 MIDDLE ADULTHOOD
 OLDER ADULTHOOD
Components of Nutritional
Assessment
 History taking
 Dietary, medical, socioeconomic data
 Physical assessments
 Anthropometric and clinical data
 Laboratory data
 Protein status, body vitamin, mineral, and trace
element status
Two Anthropometric
Measurements to Assess
Nutritional Status
Dietary Data
 24-hour recall method
 Food diaries
 Diet history
Factors to Assess for Nutritional
Status
 Usual dietary intake
 Food allergies or intolerances
 Food preparation and storage
 Dietary practices
 Eating disorder patterns
Risk Factors for Poor Nutritional
Status
 Developmental factors
 Sex
 State of health
 Alcohol abuse
 Medications
 Megadoses of nutrient supplements
FACTORS AFFECTING CLIENT’S
NUTRITION
 PHYSIOLOGIC FACTORS
 PSYCHOSOCIAL/EDUCATIONAL
 ENVIRONMENTAL/ECONOMIC/POLITICAL
PHYSIOLOGIC FACTORS

 STATE OF HEALTH: ACTIVE ILLNESS, REHABILITATIVE

PHASE, USUAL STATE OF HEALTH (HEALTHY AS
OPPOSED TO DEBILITATED), PHYSIOLOGIC
DEFORMITIES OR FUNCTIONAL LIMITATIONS
 AGE, STAGE OF DEVELOPMENT
 ALLERGIES, INTOLERANCE TO CERTAIN FOODS
 OTHERS
PSYCHOSOCIAL/EDUCATIONAL
FACTORS

 CULTURE AND PERCEPTION OF HEALTH AND

WELLNESS
 VALUE ONE PLACES ON FOOD : “I LIVE TO EAT” OR
“I EAT TO LIVE”
 PRESENCE OF MENTAL DISORDERS: ANOREXIA
NERVOSA, BULIMIA
 ADEQUATE INFORMATION AND UNDERSTANDING
OF NUTRITION
ENVIRONMENTAL/ECONOMIC/POLITICAL
FACTORS AFFECTING NUTRITION

 PRESENCE OF FRESH FOOD, TECHNOLOGY,

INCOME
 AFFORDABILITY, ADEQUACY: FOOD STAMPS,
GOVERNMENT SUBSIDIES, FOOD BANKS, BREAD
FOR LIFE
 GEOGRAPHIC LOCATION, FOOD DISTRIBUTION
LOCALLY AND WORLD-WIDE
CASE SCENARIO

 A 58 YEAR OLD FEMALE IS ADMIITED TO YOUR

MED-SURG UNIT. SHE WEIGHS 107 POUNDS AND IS
5 FEET 8 INCHES TALL. SHE REPORTS DIFFICULTY
SWALLOWING BECAUSE OF A SORE THROAT AND
A TENDENCY TO COUGH WHEN SHE DRINKS WATER
OR ANY LIQUID. SHE CAME IN WITH DIAGNOSES OF
FAILURE TO THRIVE AND ANOREXIA.
WHAT WOULD BE YOUR NURSING
ACTIONS?

 FIRST ASSESS IN ORDER TO PRIORITIZE PATIENT

NEEDS
SAFETY IS FIRST
CONSIDERATION
 DO A GENERAL SURVEY
 EXPLORE/ASSESS THE FACTORS AFFECTING THE
PATIENT’S NUTRITION
 PATIENT HAS ANOREXIA. WHAT MEASURES WILL
REDUCE ANOREXIA? NAUSEA? GAS OR
BLOATING?
 PATIENT HAS DIFFICULTY SWALLOWING: THICKEN
FLUIDS. HAVE PATIENT SIT UPRIGHT WHEN EATING
OR DRINKING
MEASURES TO PROMOTE ADEQUATE
INTAKE
 ASSESS ADVERSE REACTIONS TO EATING AND/OR
BEING FED
 LISTEN, ENCOURAGE VERBALIZATION OF FEELINGS
MEASURES TO PROMOTE ADEQUATE
INTAKE
 MONITOR STRICT INTAKE AND OUTPUT
 OPTIMAL POSITION: SAFETY AND COMFORT
 ASSIST WITH EATING AS NEEDED
 MEASURES TO PROMOTE APPETITE
 CONSIDER NUTRITIONAL SUPPLEMENTATION
 THERAPEUTIC DIETS
 AGE-RELATED, CULTURE-RELATED DIET
MODIFICATIONS
 CONSIDER ENTERAL FEEDING
 CONSIDER PARENTERAL FEEDING
WHAT IS ONE OF THE MOST
IMPORTANT NURSING INTERVENTION
IN OUR CASE SCENARIO?
 ANSWER:
 PATIENT AND NURSE THERAPEUTIC RELATIONSHIP

 OUR PATIENT HAS MANY COMPLEX ISSUES.

 FOCUS ON SAFETY
 INVOLVE PATIENT IN IDENTIFYING PRIORITIES AND
WORK COLLABORATIVELY WITH INTERVENTIONS
ADDITIONAL Nursing Interventions
 Screening for nutritional risk (physiologic,
psychosocial, environmental)
 ONGOING Observation of intake and appetite
 Evaluating the patient’s tolerance to food, use of
self-prescribed vitamin supplements

 Addressing potential for drug-nutrient reactions

Nursing Interventions (cont.)
 Obtaining more food or snacks for the patient if
appropriate
 Monitoring food brought in by visitors
 Participating in nutrition education efforts
ADDITIONAL Nursing Interventions
 Consulting with the dietitian and physician

 Preparing for discharge: assess HOME NUTRITION

 Referral to support organization
Selected therapeutic diets
1. consistent-carbohydrate diet- for type 1 and
type2 diabetes, impaired glucose tolerance
2. Fat-restricted diet- for chronic cholecystitis (to
decrease gallbladder stimulation)
3. High fiber diet- prevent or treat constipation,
irritable bowel syndrome, diverticulosis
Selected therapeutic diets
4. low-fiber diet: fiber limited to less than 10 g/day-
before surgery; ulcerative colitis; diverticulitis
5. Sodium-restricted diet: 500-3000 mg/day-
hypertension; heart failure; acute and chronic
renal disease; liver disease
6. Renal diet: protein restriction 1,000- 3,000 mg/day.
Potassium and fluid restrictions dependent on
patient situation- nephrotic syndrome; chronic
kidney disease; diabetic kidney disease.
FEEDINGS INTRAVENOUSLY

 PATIENTS WHO ARE AT HIGH RISK OF NUTRITION

IMBALANCE MAY REQUIRE NUTRITION BY MEANS
OF DIRECT ADMINISTRATION INTO A MAJOR VEIN.
 Total parenteral nutrition (TPN)
 Peripheral parenteral nutrition (PPN)
Complications of Parenteral
Nutrition
 Insertion problems
 Infection
 Metabolic alterations
 Fluid, electrolyte, and acid–base imbalances
 Phlebitis
 FEEDING VIA THE GI TRACT
providing enteral nutrition
 SHORT-TERM NUTRITIONAL SUPPORT
- Less than 4 weeks
- Nasogastric tube (NG tube) is inserted through the
nose into the stomach
- Example: Levin tube
- Nasointestinal tube (NI tube) is passed through the
nose and into the upper portion of the small intestine.
 FEEDING VIA THE GI TRACT
providing enteral nutrition
 LONG-TERM NUTRITIONAL SUPPORT
- More than 4 weeks
Gastrostomy tube
Percutaneous endoscopic gastrostomy (PEG tube)
Low profile gastrostomy device (LPGD)
Jejunostomy tube
FEEDING VIA THE GI TRACT: criteria-
feeding tolerance include
 Absence of nausea and vomiting
 Minimal or no gastric residual
 Absence of diarrhea and constipation
 Absence of abdominal pain and distention
 Presence of bowel sounds within normal limits
FEEDING VIA THE GI TRACT: nursing
considerations
 Promote patient safety
 Monitor for complications
 Provide comfort measures
DIETARY DATA TO BE INCLUDED IN
THE PATIENT’S CHART
 TYPE OF DIET, AMOUNT, FREQUENCY AS
APPRPRIATE
 ANY ALLERGIES OR FOOD INTOLERANCE
 ANY FOOD-DRUG INTERACTIONS
 DIETARY PREFERENCES
 MONITORING FOR INTAKE AND OUTPUT
Assisting patient with NG
tube feeding
 What are Nursing responsibilities?
Assisting patient with G-
tube
 NURSING RESPONSIBILITIES
reference
 Taylor, Lillis and Lynn, Fundamentals of Nursing,
Wolters Kluwer, Philadelphia, PA, 8th ed., 2015