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Nutrition and

Metabolism
Nurse Licensure Exam Review
Nutrition and
Metabolism
It is the nurses’
responsibility to maintain
and restore optimal BODY
function by providing
enough nutrients for tissue
repair, for healthy immune
system and for life
processes to proceed
Definition of Terms
•NUTRITION- the sum
of all the
interactions
between an
organism and the
food it consumes.
Definition of Terms
•Nutrients- are
organic and inorganic
substances found in
foods and are
required for body
functioning
Definition of Terms
•Metabolism- sum
total of all body
processes
(biochemical and
physiological) to
maintain life and
growth
Definition of Terms
•Anabolism- a type of
metabolism
characterized by
synthesis/building of
products
Definition of Terms
•Catabolism- a
type of
metabolism
characterized by
breakdown of
products
Definition of Terms

•Energy Balance-
the relationship
between the
energy derived
from food and the
energy used by
Nutrients

Macro Nutrients
•Carbohydrates
•Fats
•Proteins
Fig. 16.22
Nutrients
Micro Nutrients
•Vitamins
– Fat soluble
– Water soluble
•Minerals
– Macrominerals
– Microminerals
CARBOHYDRATES

•Composed of
elements- carbon,
hydrogen and
oxygen
•The preferred
source of energy
CARBOHYDRATES

•Generally
categorized into
two basic kinds-
–Simple
carbohydrates
–Complex
CARBOHYDRATES

•These include
sugars (simple),
starches
(complex), and
cellulose
CARBOHYDRATES

•Calorie
provided by
ONE gram of
Carbohydrates
is 4 Kcal/gram
CARBOHYDRATES

•Function to
promote normal fat
metabolism, spare
protein, and
enhance lower GIT
function
CARBOHYDRATES

•Major food
sources include
milk, grains,
fruits, and
vegetables
CARBOHYDRATES

•Inadequate intake of
carbohydrate affects
metabolism
•The blood glucose is
maintained within
relatively narrow limits
of 80-109 mg/dL.
Carbohydrate Sources

1. SIMPLE SUGARS
2. COMPLEX CHO-
STARCHES
3. COMPLEX CHO-
FIBER
Carbohydrate Sources

1. SIMPLE SUGARS-
these are water-
soluble
carbohydrates
produced by
animals and
Simple Sugars
Monosaccharides
It can be monosaccharide:
b. Glucose
c. Fructose
d. Mannose and
e. Galactose
GLUCOSE is the most
abundant.
Simple Sugars:
Disaccharides
Disaccharides
b.Sucrose
c.Lactose
d.Maltose
Complex Carbohydrates
2. COMPLEX CHO-
STARCHES- these are
PARTIALY insoluble in
water, non-sweet form of
CHO.
Plant starches are AMYLOSE
and AMYLOPECTIN.
Glycogen is the counterpart
Complex Carbohydrate

3. COMPLEX CHO-
FIBER- derived from
plants, this cannot
be digested by
humans but very
essential for
roughage, and adds
Carbohydrate
Metabolism
• Ingestion
• Digestion
• Absorption
• Transport
• Assimilation
• Storage
• Metabolism
Carbohydrate Metabolism
Digestion
Digestion of
carbohydrates begins
in the mouth
Salivary glands secrete
enzyme called
SALIVARY AMYLASE
(Pyalin)
Carbohydrate Metabolism
Digestion
Digestion of
carbohydrates begins
in the mouth
Starches are converted
to mixed dextrin, and
simple sugars (mono
and di)
Carbohydrate Metabolism
Digestion
•The next site of
digestion is the SMALL
Intestine
•Enzymes present in the
SI
–Pancreatic Amylase
–Intestinal
Carbohydrate Metabolism
Digestion
•PANCREATIC
AMYLASE
–Secreted by pancreas
–Breaks down mixed
dextrin to
disaccharides
Carbohydrate Metabolism
Digestion
•Intestinal
Disaccharidase
–Secreted by
enterocytes
–Breaks down
disaccharides to
monosaccharides for
Carbohydrate Metabolism
Absorption
•Intestinal Mucosa
–Has numerous finger-
like projection called
“villi”
–Absorption takes
place here
Carbohydrate Metabolism
Transport
•Portal vessels
–Will carry the blood
(rich in nutrients)
from the intestine to
the LIVER
Carbohydrate Metabolism
Storage
•Liver
–Will convert the
monosaccharides into
glucose
–Stores glucose as
GLYCOGEN
Carbohydrate Metabolism
Use
•Liver
–Will break down
Glycogen into glucose
–Releases the Glucose
to the blood for
utilization
Carbohydrate Metabolism
Use
•Hormones that
influence Glucose
utilization and
Metabolism:
•Insulin
•Glucagon
Carbohydrate Metabolism
Use
Insulin
•Secreted by the
pancreas islets of
Langerhans (BETA
cells)
•Released in response
to increased glucose
Carbohydrate Metabolism
Use
Insulin
•Promotes GLUCOSE
breakdown
–GLYCOLYSIS
Carbohydrate Metabolism
Use
Insulin
•Also promotes
GLYCOGEN
production
–GLYCOGENESIS
Carbohydrate Metabolism
Use
Glucagon
•Also secreted by the
pancreatic islets of
Langerhans (alpha
cells)
Carbohydrate Metabolism
Use
Glucagon
•Promotes Glucose
Synthesis
–GlucoNEOgenesis
Carbohydrate Metabolism
Use
Glucagon
•Promotes Glycogen
Breakdown
–Glycogenolysis
Sugar Hormones
• Insulin • Glucagon
• Decreases • Increases
blood blood
glucose glucose
• glycogenESI • glyconeoLYS
S IS
• glycolysis • glucoNEOge
nesis
Lipids

•These are
heterogeneous group
of organic substances
that are “greasy” and
insoluble in water but
soluble in alcohol and
ether.
Lipids

•Solid lipids are called
“fats” and liquid lipids
are called “oils”
•Similar to
carbohydrates, lipids
contain carbon, oxygen
and hydrogen
Lipids: Functions
• Provide a concentrated
source and a stored
abundant form of energy
• Protect internal organs
and maintain body
temperature
• Enhance absorption of
Lipids

•Calorie
provided by
ONE gram of
fats is 9
kcal/gram
Lipids

•Inadequate fat intake
leads to clinical
manifestations of
sensitivity to cold, skin
lesions, increased risk
of infection and
amenorrhea in women
Lipids

•Diets high in fat can
lead to obesity and
increase the risk of
cardiac disease and
some cancers
Lipids
SOURCES OF FATS
• 1. FATTY ACIDS- these are
the basic structure of most
BODY and DIETARY lipids.
• These can be saturated (with
single bonds) or
• unsaturated (with double
bonds).
Lipids
•Fatty acids are found in
TRIGLYCERIDES, the
most common form of
simple lipid.
•Triglyceride has a
backbone of GLYCEROL
with 3 fatty acids.
Lipids
• 2. COMPOUND LIPIDS-
HDL, LDL and
Chylomicrons are some
examples.
• These compounds have
lipids, proteins and
cholesterol.
Lipids

•Cholesterol is a lipid
produced by the
body and found in
foods of animal
origin.
Lipids

• Cholesterol is
needed to produce
bile acids, vitamin D,
steroid hormones
and cell membranes.
Lipid Metabolism
•DIGESTION OF LIPIDS
•Some chemical
digestive process can
occur in the mouth via
the action of salivary
lipase.
•This digestion is
usually considered
Lipid Metabolism
•DIGESTION OF LIPIDS
•The GASTRIC Lipase
can break down the
lipids in the stomach
•This is the initial
digestion of lipids
Lipid Digestion
• The main digestion of
lipids occurs in the small
intestines where the
action of the enzymes
pancreatic lipase (from
the pancreas), bile acids
and intestinal lipase break
down lipids into simple
Lipid Digestion

•The end products of
lipid digestion are:
• 2-glycerol
• fatty acids
• and cholesterol
Lipid Absorption
• These products are
reassembled into
triglycerides by the
intestinal cells and are
carried into the
lymphatic vessels as
chylomicrons or
lipoproteins
Lipid Transport
• The Lipoprotein is carried in
the lymphatic vessels
called LACTEALS
• They are not carried to the
portal-liver circulation.
• Lymphatic vessels drain the
“chyle” to the superior
vena cava
Lipid Storage

•Lipids are stored
in the liver and
adipose tissues.
Lipid utilization and
production
• The breakdown of lipids is
called lipolysis
• The body can also produce
fatty acids, cholesterol
and lipoproteins (VLDL
and HDL) HDL is the
“good” lipoprotein; LDL is
the “bad” lipoprotein.
Essential fatty acids

•Our body cannot
produce two important
fatty acids
– LINOLENIC and
– LINOLEIC acids.
•Arachidonic acid can be
derived from Linoleic
PROTEINS
• Made of Organic
substances – carbon,
hydrogen, oxygen and
nitrogen
• Made from amino acids,
critical to all aspects of
growth and development
of body tissues
PROTEINS

•Calorie
per ONE
gram of
Protein is
4
kcal/gram
PROTEIN Functions
• Essential for building and
repair of body tissues,
regulation fluid balance,
maintenance acid-base
balance, production of
antibodies, provision of
energy and production of
enzymes and hormones
PROTEIN building blocks:
Amino acids
•AMINO ACIDS can be
categorized as
essential and non-
essential based on
dietary requirements
PROTEIN building blocks:
Amino acids
•Essential amino acids
are required in the diet
because the body
cannot manufacture
them. There are 9
essential and 1 semi-
essential
PROTEIN: Amino Acids
• Essential amino acids (PVT
TIM HALL) Phenylalanie,
Valine, Tryptophan.
Threonine, Isoleucine,
Methionine, Histidine,
Arginine (the semi-
essential), Leucine and
Lysine
PROTEINS: Amino Acids

•Nonessential amino
acids are those that
the body can
manufacture and are
not needed in the
diet.
Protein : Sources
• SOURCES OF PROTEINS
• 1. COMPLETE PROTEIN-
these foods contain all the
essential amino acids
aside from the
nonessential ones. Meat,
eggs, poultry, fish and
dairy products are
complete proteins. These
Protein Digestion
• The small intestine is the
final site of digestion of
proteins where the
enzymes trypsin (from
pancreas), chymotrypsin
(from pancreas) and
carboxypeptidases (from
pancreas also) further
Protein Sources
•2. INCOMPLETE
PROTEIN- foods that
lack ONE or more
essential amino acids.
Vegetables are usually
the foods that lack one
or more essential
amino acids.
Protein Sources
•In order to become
complete, a
combination of
vegetables and fruits
called “complementary
protein foods” can
augment the intake of
essential amino acids
Protein Digestion
• The most important initial
digestion begins in the
stomach
• The enzyme PEPSIN
(secreted by the CHIEF
CELLS) in the stomach
breaks down complex
proteins into simple
Protein Digestion

•The HCL, secreted by
the PARIETAL CELLS,
activates Pepsinogen
to PEPSIN
Protein Digestion
• Parietal cells also secrete
INTRINSIC factor needed
to absorb Vitamin B12
• Lack of intrinsic factor will
impair Vitamin B12
absorption leading to
Pernicious anemia
Protein Digestion

•The final enzymes
come from the
intestinal cells
•Peptidase and
dipeptidase
completely digest the
Protein Absorption and
transport
• Amino acids are absorbed
from the intestine enter
the portal circulation
• The liver takes the amino
acids for synthesis of
plasma proteins and
specific enzymes.
Protein Absorption and
transport
•The other amino acids
are transported to the
tissues and cells where
they are used to
manufacture cellular
proteins.
Protein balance

•Nitrogen balance- is a
measure of the degree
of protein anabolism
and catabolism.
• This balance occurs
when the nitrogen
input equals the
Protein balance

•Positive nitrogen
balance- exists when
the intake of nitrogen
is greater than the
amount excreted.
• Example situations-
pregnancy, recovery
Protein Balance

•Negative nitrogen
balance –exists when
the excretion of
nitrogen exceeds the
intake of nitrogenous
proteins.
Protein Balance
• Negative nitrogen
balance
• Example situations-
inadequate intake of
proteins, tissue
breakdown, surgery and
acute or early stage of
Micronutrients

•These are nutrients
needed by the body in
small quantities

•Vitamins and minerals
are examples of
micronutrients
Vitamins
• 1. VITAMINS- are organic
compounds that cannot be
synthesized by the body
(except Vit. D).
• These are needed for
cellular metabolism, but
they do not supply
energy.
Vitamins

•Vitamins can be
classified according to
their solubility
•water soluble vitamins
are (Vitamins B and C)
and
•Lipid soluble vitamins
Vitamin A

•Retinoic acid
•Retinol
•Retinal
•Functions: Vision,
epithelial maturation
and antioxidant
Vitamin D

•Cholecalciferol

•Function: Calcium
metabolism
Vitamin E

•The tocoperols

•Function: Antioxidant,
reproductive function
Vitamin K

•Menadione

•Function: synthesis of
clotting factors 2, 7, 9
and 10
Vitamin C

•Ascorbic Acid

•Functions:
•Collagen formation
•Antioxidant
•Immune system
Vitamin B complex
• B1= Thiamine
• B2= Riboflavin
• B6= Pyridoxine
• B12= Cobalamin
• Niacin
• Biotin
• Panthotenic acid
• Folic Acid
Micronutrients: Minerals
•2. MINERALS- are
substances that can be
found in organic
compounds, or they
can be found as
inorganic compounds
and they also can be
found as free ions.
Micronutrients: Minerals
• Macrominerals are those
that are needed daily in
amount of more than
100 milligrams
• Examples include
calcium, potassium,
sodium, magnesium,
chloride and sulfur
Micronutrients: Minerals
• Microminerals are those
that are required by the
body less than 100
milligrams.
• Examples include zinc,
iron, manganese, iodine,
fluorine, copper, cobalt,
chromium and selenium
NUTRITION in Nursing

•CHARACTERISTICS OF
NORMAL NUTRITON
•For energy balance to
occur
• energy input must
equal energy output
NUTRITION in Nursing
• 1. ENERGY INPUT
• The amount of energy that
nutrients or foods supply to
the body is the caloric
value
• Calorie is the unit of heat
energy required to raise
the temperature of 1 gram
NUTRITION in Nursing

•A kilocalorie is the
amount of heat
required to raise the
temperature of 1 gram
of water 15-16 degrees
Celsius. This is the unit
used in NUTRITION
NUTRITION in Nursing

•1 kcal= 4.18 kilojoules
•Carbohydrates= 4
Kcal/gram
•Proteins= 4 Kcal/gram
•Fats= 9 Kcal/grams
•Alcohol= 7 Kcal/grams
Nutrition in Nursing

• 2. ENERGY OUTPUT
•Metabolic rate is
expressed in terms of
the rate of heat
liberated during
chemical reactions
Nutrition in Nursing
• The RESTING ENERGY
EXPENDITURE (REE) is the
amount of energy required
to maintain basic functions
to maintain life.
• This is usually 1 Kcal/kg/hr
of body weight. Example:
70 kg male X 1 kcal/kg/hr=
Nutrition in Nursing
• The BASAL METABOLIC
RATE (BMR) is the rate at
which the body metabolizes
food to maintain the energy
requirements of a person
who is awake and at rest.
• REE X 24 hours= BMR
• 70 kg male X 1 kcal/kg/hr X
24 hr= 1680 kcal/day
Body Weight

•IDEAL BODY
WEIGHT is the
optimal weight
recommended for
optimal health.
Body Weight
•This is conveniently
computed by using
various formulas like
the Tanhausser’s
method
The rule of 5
•(5-foot woman should
weigh 100 pounds, with
additional 5 lbs per
additional inch) and
•6 (6-foot man should
weigh 105 pounds with
additional of 6 pounds
Body Weight

•This can also be
computed by using
standardized tables.
Body Mass
•BODY MASS INDEX-
is used as an
indicator of changes
in body fat stores
and whether a
person’s weight is
appropriate for
height. This may be
used to estimate
Body Mass
• the formula for BMI is
Weight in KILOGRAMS
divided by HEIGHT in
meters squared.

Weight in Kilograms
__________________

Meters squared
Body Mass
• BMI of less than 16 is
malnourished,
• BMI of 16-19 is undernutrition
• BMI of 20-25 is normal
• BMI of 26-30 is overweight
• BMI of 31-40 is mod-severely
obese
• BMI of > 40 is morbid obesity
Factors affecting
Nutrition
• 1. Stage of Development
• 2. Gender
• 3. Ethnicity and Culture
• 4. Personal Beliefs
about food
• 5. Personal Preferences
Factors affecting
Nutrition
• 6. Religious practices
• 7. Lifestyles and Habits
• 8. Medications and
Therapy
• 9. State of Health
• 10. Psychological factors
• 11. Economic factors
What is a healthy diet?
• STANDARDS OF A
HEALTHY DIET
• 1. The dietary guideline
for Filipinos
• Developed by the Food
and Nutrition Research
Institute
What is a healthy diet?
2. The Food Guide Pyramid
• Developed by the USDA
• This pyramid suggests
that people eat a variety
of foods to obtain the
nutrients they need
What is a healthy diet?

•It divides food into
five food groups. The
foods needed in
largest amount are
the group of bread,
cereals, rice and
pasta.
What is a healthy diet?

•This guide is easy to
follow and people
who eat a variety of
foods from each
group are likely to
come close to
recommended
What is a healthy diet?

•This pyramid does
not address the fluid
intake or provide the
guidelines on
combination foods.
What is a healthy diet?

•3. Vegetarian Diets
Malnutrition
• MANIFESTATIONS OF
ALTERED NUTRITION
– OVERWEIGHT
– OBESE
– UNDERWEIGHT
Malnutrition

•OVERWEIGHT- 10-20%
more than the ideal
body weight.
• This usually happens
when the person eats
more calories than
expended.
Malnutrition

•OBESITY- weight of
more than 20%. Morbid
obesity can interfere
with normal
functioning such as
mobility or breathing
Malnutrition

•UNDERWEIGHT-
weight less than
10-20% of the
ideal body weight
Malnutrition
• MANIFESTATIONS OF ALTERED
NUTRTION
– RECENT SIGNIFICANT
WEIGHT LOSS
– DECREASED ENERGY
– ALTERED BOWEL PATTERNS
– ALTERED SKIN, TEETH,
NAILS AND MUCUS
MEMBRANE
Nursing Process and
Nutrition
• ASSESSMENT
• The purpose of nutritional
assessment is to identify
clients at risk for malnutrition
and those with poor
nutritional status.
• Nurses generally perform
nutritional screening for rapid
assessment.
Nursing Assessment
• NUTRITIONAL SCREENING-
assessment performed to
identify clients at risk for
malnutrition.
• This can be done by using
a screening form, by
nursing history and
dietary history and
physical examination
Nursing Assessment
• NURSING HISTORY- data
obtained in the routine
nursing history usually
contain nutrition-related
information. Questions
related to this include-
changes in appetite,
changes in weight,
Nursing Assessment
•PHYSICAL
EXAMINATION- this
reveals nutritional
deficiencies and
excesses in addition to
obvious weight
changes.
Nursing Assessment

• Assessment of the
general appearance, skin,
hair, nails, eyes, mucosa
and other systems can be
done to ascertain
nutritional status. Height
and weight measurements
are also taken
Nursing assessment

•CALCULATION OF IDEAL
BODY WEIGHT AND
BODY MASS INDEX
Nursing assessment

•Dietary History
– 24 hour food recall
– Food frequency record
– Food diary
Nursing assessment
• DIETARY HISTORY- this
includes data about the
client’s usual eating
patterns and habits; food
preferences, allergies and
intolerance: frequency and
types of foods consumed;
and social, economic,
ethnic, and religious
Nursing assessment

24-hour food recall
• This is the most
practical method where
the nurse asks the
person to recall the
type, quality and food
preparation of food
Nursing assessment

•Food frequency record
•Provides information
about the types of
food eaten and not
the quantity.
Nursing assessment

Food Diary
• A detailed record of
measured amounts of
all foods usually 3 days
to 1 week period.
Nursing assessment
• ANTHROPOMETRIC
MEASUREMENTS- these
are non-invasive
techniques that aim to
quantify changes in body
composition.
Nursing assessment
• MIDARM circumference (MAC)
is a measure of fat, muscle and
skeleton.
• MID-ARM MUSCLE
circumference (MAMC) is
calculated by using reference
tables that incorporates the
triceps skinfold and the mid-
arm circumference.
Nursing assessment
• LABORATORY DATA- lab tests
results can provide objective
data to the nutritional
assessment. There is no
single test that can
specifically predict nutritional
risks. The tests most
commonly used are
• SERUM PROTEINS, URINARY
Nursing Diagnoses
• Imbalanced Nutrition: More
than Body Requirements
• Imbalanced Nutrition: Less
than Body Requirements
• Risk for Imbalanced Nutrition
• Constipation
• Risk for infection
• Diarrhea
Nursing Planning
Major goals for clients with or at risk
for nutritional problems are:
• 1. To maintain or restore optimal
nutritional status
• 2. To promote healthy nutritional
practices
• 3. To prevent complications
associated with malnutrition
• 4. To decrease weight or to regain
additional weight to reach ideal
levels
Nursing implementation

•The Nurse reinforces
nutritional instructions,
creates an atmosphere
that encourages
eating, and provides
assistance with eating
Nursing implementation

•The Nurse monitors
client’s appetite and
food intake;
administers special
diet through enteral
(through GIT) and
parenteral (Through
Nursing implementation

•The Nurse consults
with the physician and
nutritionist about the
nutritional problems of
the client.
Nursing implementation
• ASSIST WITH SPECIAL DIETS-
hospitalized patients may need
special diets ranging from
regular diet to clear liquid, full
liquid and soft diets.
a. Clear liquid diet
b. Full liquid diet
c. Soft diet
d. Bland diet
e. Diet as tolerated
Liquid Diet vs Soft diet
Clear liquid Full liquid Soft diet
Coffee Clear liquid All CL and FL
Tea PLUS: plus:
Carbonated Milk/Milk Meat
drink prod Vegetables
Bouillon Vegetable Fruits
juices
Clear fruit Breads and
juice Cream, cereals
Popsicle butter Pureed foods
Yogurt
Gelatin
Hard candy Puddings
Nursing Implementation
STIMULATE CLIENT’S
APPETITE-
a. Provide familiar food
b. Select small proportions
c. Provide clean
environment, oral hygiene,
give pain medications first
and reduce stress
Nursing Implementation
ASSIST CLIENT with MEALS-
Hospital provides trays
and eating utensils for the
patients.
Older adults and
handicapped patients
need special assistance
from the nurse
Nursing Implementation

PROVIDE ENTERAL
NUTRITION
Enteral route of
nutrition refers to
feeding through the
gastrointestinal
Nursing Implementation
• Typical examples are the
Nasogastric feeding
• Gastrostomy feeding
(opening into the
stomach)
• Jejunostomy feeding
(opening into the jejunum)
Nursing Implementation
PROVIDE PARENTERAL
FEEDING
Parenteral nutrition is provided
when the gastrointestinal
tract is non-functional.
• It can be otherwise called TPN
or IVH (intravenous
hyperalimentation).
Nursing Evaluation

The goals established
during the planning
phase are evaluated
to determine the
success.
In Summary
• Adequate nutritional
intake is important to
maintain body functions,
promote healing, maintain
healthy tissues, maintain
body temperature and
build resistance to
infection
In Summary
•Essential nutrients
are carbohydrates,
protein, fat,
vitamins, minerals
and water
In Summary

•Complex physiologic
processes permit the
body to break down
food so that it can be
used by the body as
energy
In Summary

•Great variations exists
in dietary intake
among different
people, but guidelines
such as food groups,
RDA and caloric intake
can be evaluated
In Summary
• Many factors affect
normal eating patterns
• Manifestations of altered
nutrition include
over/underweight, weight
loss, decreased energy,
altered skin and mucus
membrane
In Summary

•Nutritional needs
vary across the
lifespan
In summary

•Nutritional Assessment
includes collecting
subjective data on
normal eating patterns,
risks factors for
nutritional deficits and
identification of altered
In summary

•Anthropometric
measurements can
provide objective data
to help assess a
patient’s nutritional
state
In summary

•Nursing diagnoses
applicable are:
Imbalanced
nutrition, Risk for
infection, etc
In summary

•Nursing intervention to
promote optimal
nutrition include
patient teaching,
measures to encourage
eating, nutrition
program and provision
In summary
• Therapeutic diets are used
to promote health
• Evaluation of nutritional
goals are done to
determine the success of
the interventions